Intended for healthcare professionals

Practice 10-Minute Consultation

Otitis media with effusion (“glue ear”)

BMJ 2011; 343 doi: (Published 04 July 2011) Cite this as: BMJ 2011;343:d3770
  1. Amir Farboud, specialist registrar in ear, nose, and throat surgery 1,
  2. Richard Skinner, general practitioner2,
  3. Rohit Pratap, locum consultant ear, nose, and throat surgeon3
  1. 1Charing Cross Hospital, London W6 8RF, UK
  2. 2Bryntirion Surgery, Bargoed CF81 8SA, UK
  3. 3Watford General Hospital, Watford WD18 0HB, UK
  1. Correspondence to: A Farboud amirfarboud{at}
  • Accepted 28 March 2011

A mother brings her 5 year old son to your practice, concerned about his difficulty hearing her and his poor attentiveness in school. She is worried that his speech is not developing as quickly as his peers’. He recently had severe earache, which resolved when the ear started discharging. He was treated on that occasion with oral antibiotics. On examination the tympanic membrane appears grey with an absent light reflex.

Otitis media with effusion (“glue ear”)

Eighty per cent of children under 10 years old will have had at least one episode of otitis media with effusion (OME) (figure). Bimodal peaks occur at age 2 and 5 years. The condition is often relapsing and remitting: an episode usually lasts for 6-10 weeks. In severe and persistent cases, permanent retraction and atrophy of the tympanic membrane can occur, occasionally leading to retraction pockets and ultimately cholesteatoma. However, the main concern in OME is the associated conductive hearing impairment, and the repercussions this can have for a child’s education and speech and language development. The exact cause of the condition is not clearly understood , but it arises from eustachian tube dysfunction, causing chronically low pressure in the middle ear. This then leads to an inflammatory response in the middle ear mucosa, with production of fluid or “glue.”

Appearances of the tympanic membrane. Left to right: normal; otitis media with effusion; cholesteatoma

What you should cover

  • Focus on the duration of the child’s …

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