2
Diagnosis
Key Points
Î Otitis media with effusion (OME) is defined as the presence of fluid in
the middle ear (Figure 1, Table 1) without signs or symptoms of acute
ear infection.
• By contrast, acute otitis media (AOM) is the rapid onset of signs and symptoms of
inflammation in the middle ear, most often with ear pain and a bulging eardrum.
Î Synonyms for OME include ear fluid and serous, secretory, or
nonsuppurative otitis media.
Î About 90% of children have OME before school age, and they develop,
on average, 4 episodes of OME every year.
• In the first year of life, >50% of children will experience OME, increasing to >60%
by age 2 years.
Î OME is largely asymptomatic, and many episodes are therefore
undetected, including those episodes in children with hearing
difficulties or school performance issues.
• When children aged 5-6 years in primary school are screened for OME, about 1 in
8 are found to have fluid in one or both ears.
Î The prevalence of OME in children with Down syndrome or cleft palate,
however, is much higher, ranging from 60-85%.
Î Most episodes of OME resolve spontaneously within 3 months, but
about 30%-40% of children have repeated OME episodes and 5%-10%
of episodes last ≥1 year.
Î At least 25% of OME episodes persist for 3 months or longer and may
be associated with hearing loss, balance (vestibular) problems, poor
school performance, behavioral problems, ear discomfort, recurrent
AOM, or reduced QOL.
• Less often, OME may cause structural damage to the tympanic membrane that
requires surgical intervention.
