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Otitis media is an inflammation of the middle ear. Otitis media with effusion (OME) refers to fluid in the middle ear space, but without the symptoms of an acute infection. Children with acute otitis media (acute ear infection) have fluid in the middle ear accompanied by signs or symptoms such as ear pain, redness of the eardrum, or fever. Children with an acute ear infection act sick, especially at night. Children with OME do not.

The fluid in OME is often thin and watery. "Glue ear" is a common name given to OME with thick, viscous effusion (fluid).

Causes and Risks

In the United States, there are over 25 million visits to pediatricians each year related to ear infections, making it the most common diagnosis for children. Almost every acute ear infection is followed by days or weeks of OME. In addition, many people develop OME without first having acute inflammation.

OME is caused when the Eustachian tube, a narrow channel that connects the inside of the ear to the back of the throat, becomes blocked. This tube is a drainage conduit to prevent the build-up of secretions that are normally made in the middle ear. These secretions drain down the tube and are swallowed. The tube also functions to keep the air space in the middle ear at the same pressure as the air around us. In this way, the eardrum can move freely, and our hearing is most effective.

When all is well, the tube is collapsed most of the time in order to protect the middle ear from the many organisms that live in the nose and mouth. Only upon swallowing does a tiny muscle open it briefly to equalize the pressures and drain the ear secretions. If any bacteria make it into the ear, the drainage mechanism, helped by little hair cells, should flush it out.

When the Eustachian tube is partially blocked, fluid accumulates in the middle ear. Bacteria already there are trapped and begin to multiply.

Respiratory infections, irritants (especially cigarette smoke), and allergies can all inflame the lining of the tube, producing swelling and increased secretions. They can also cause enlargement of the adenoid glands near the opening of the tube, blocking flow at the outlet. Sudden increases in air pressure (during descent in an airplane or on a mountain road) can squeeze the floppy tube closed and create a relative vacuum in the ear. Drinking while lying on one's back can close the slit-like tube opening. Although a myriad of factors can lead to a blocked tube, getting water in a baby's ears won't.

The last two decades of the 20th century saw a dramatic rise in OME, largely due to increased pollution and the prevalence of early childhood day care (where children are exposed to many respiratory infections).

OME is most common in winter or early spring, but can occur at any time of year. The highest incidence is in children under 2 years old, but it can occur in people of any age.

Small children get more OME than older children or adults for several reasons: The tube is shorter, more horizontal, and straighter (quick and easy trip for the bacteria). The tube is floppier, with a tinier opening (easier to block). And young children get more colds (it takes time for the immune system to be able to recognize and ward off cold viruses).

It used to be thought that the longer the fluid was present, the thicker it became. Thus, the term "glue ear" became synonymous with chronic OME. It is now thought that the thickness of the fluid relates more with the particular ear than with how long the fluid is present.