Intended for healthcare professionals

Practice Guideline

Otitis media with effusion in under 12s: summary of updated NICE guidance

BMJ 2023; 383 doi: (Published 09 November 2023) Cite this as: BMJ 2023;383:p2314
  1. Rachel Connolly, technical analyst1,
  2. Aye Paing, technical analyst1,
  3. Tim Reeves, guideline lead1,
  4. Devavrata Joshi, general practitioner2,
  5. Veronica Kennedy, consultant audiovestibular physician3,
  6. Jennifer Royds, lay member
  7. On behalf of the Guideline Committee
  1. 1National Institute for Health and Care Excellence, London, UK
  2. 2Parkbury House Surgery, St Albans, UK
  3. 3Bolton NHS Foundation Trust, Bolton, UK
  1. Correspondence to: T Reeves timothy.reeves{at}

What you need to know

  • Refer patients with suspected otitis media with effusion (OME), for age and developmentally appropriate assessment of hearing so OME can be diagnosed and potential hearing loss investigated

  • Do not use antibiotics, oral or nasal steroids, antihistamines, leukotriene receptor antagonists, mucolytics, proton pump inhibitors or anti-reflux medications, or decongestants for treatment

  • Consider off-label use of non-ototoxic topical antibiotic drops, such as ciprofloxacin, in the treatment of otorrhoea after grommet insertion

  • Give information and advice to children, parents and carers on how children can be supported at home and in the educational setting to help mitigate the impact of OME and associated hearing loss

Otitis media with effusion (OME), commonly known as glue ear, is the presence of fluid in the middle ear in the absence of infection. It differs from acute otitis media, which is an infective condition and often presents with ear pain and discharge. Across the United States and Europe, up to 80% of children are affected by OME by 4 years of age, but prevalence declines beyond 6 years of age.1 Although OME does not always impact on hearing and many cases of OME resolve within 3 months, OME is the most common cause of temporary and fluctuating hearing impairment in childhood and can have a major impact on children.

The National Institute for Health and Care Excellence (NICE) guideline covering otitis media with effusion in under 12s was first published in 2008.2 This article summarises the 2023 guideline, focusing on updated recommendations relevant to primary care.


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the guideline development group's experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square …

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