Related concepts:

Serous otitis media, secretory otitis media, silent otitis media, ear infection, silent ear infection

Introduction to otitis media with effusion:

Parents are often surprised to learn that their child has an ear infection. The infection is discovered during a visit for another purpose altogether. Even though silent ear infections cause no obvious symptoms, the child’s hearing is decreased while fluid remains in the ear. Moreover, OME often comes during the same months when children are trying to make sense of the language they hear around them.

Fluid in the middle ear, which often goes undetected for weeks or months at a time, is an important hidden problem. OME is the leading cause of surgery in children, because this silent occupant of our children's ears can have lingering effects years after the fluid has disappeared.

What is otitis media with effusion?

First, let’s discuss the structure of the ear. There are three main parts to the ear – the outer, middle, and inner ear. The outer ear includes the pinna (the visible portion of the ear) and the external auditory canal (the small tube you see doctors looking into). The external auditory canal is separated from the middle ear by the tympanic membrane (eardrum). The middle ear consists of three tiny bones that transmit sound vibrations. It is connected to the back of the throat by a tiny tube called the Eustachian tube. The inner ear consists of a hollow region inside the skull where sound vibrations are converted into nerve impulses—messages that travel to the brain.

Otitis media with effusion (OME) is the name for fluid in the middle ear without other symptoms. This fluid generally contains bacteria. Nevertheless, children with OME act as if they feel well. Because it is often discovered on routine well-child checks, it is sometimes called silent otitis media.

Acute otitis media (AOM) refers to fluid in the middle ear accompanied by signs or symptoms of an ear infection, such as pain, redness, or a bulging eardrum. Children with AOM act sick (especially at night) and often have fevers.

When children are taken to the doctor because they seem like they have an ear infection, the visit is about AOM. This article is about OME.

The Eustachian tube is a small canal that connects the middle ear to the back of the throat. When bacteria make their way into the middle ear, they are supposed to be flushed out through the Eustachian tube. When the Eustachian tube is blocked, or isn’t functioning properly, bacteria-containing fluid can become trapped in the middle ear. This causes OME.

Getting soap or water in a child’s ears does not cause OME (though in older children it can cause swimmer’s ear – a superficial infection of the skin in the ear canal).

Who gets otitis media with effusion?

OME is most common in someone who already has a cold or other upper respiratory infection. It commonly precedes an acute ear infection (AOM).