Dawaa Reference

Clinical reference

Otitis Media with Effusion (Glue ear)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

Otitis Media With Effusion - StatPearls (NCBI Bookshelf NBK538293) - https://www.ncbi.nlm.nih.gov/books/NBK538293/: "For most children diagnosed with OME, conservative treatment with watchful waiting is recommended within the first 3 months of diagnosis." and "Autoinsufflation involves forcing air from the nose and throat into the middle ear to equalize pressure and promote drainage." · No labelled dose - isotonic saline irrigation, used as often as it helps

Verified against3 documents
  • Otitis Media With Effusion - StatPearls (NCBI Bookshelf NBK538293) - https://www.ncbi.nlm.nih.gov/books/NBK538293/: "For most children diagnosed with OME, conservative treatment with watchful waiting is recommended within the first 3 months of diagnosis." and "Autoinsufflation involves forcing air from the nose and throat into the middle ear to equalize pressure and promote drainage."
  • No labelled dose - isotonic saline irrigation, used as often as it helps
  • Otitis Media with Effusion (Glue ear) - disease-level clinical article (otitis-media-with-effusion-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • Hearing loss is the symptom patients and families report most often [hearing loss]
  • Can bring communication delays, academic struggles, behavioral or sleep problems, and social withdrawal in children [social withdrawal]
  • In adults the effusion is usually one-sided and follows an upper respiratory infection, with hearing loss, tinnitus, or ear fullness [hearing loss · tinnitus]
  • Adult fluid buildup often follows pressure changes from flying or diving

Signs — what you find (2)

  • Reduced eardrum mobility and light reflex on pneumatic otoscopy support the diagnosis
  • The eardrum may show air bubbles, a fluid film, cloudiness, or a bluish or yellowish tinge

Tests (6)

  • A flat tympanogram supports the diagnosis
  • ABR confirms hearing loss in infants who fail newborn screening but misses the conductive loss caused by effusion
  • OAE screening lacks specificity and can be thrown off by background noise
  • Conductive loss from OME can produce an air-bone gap greater than 15 dB HL
  • CT can rule out cholesteatoma or other middle ear disease, and extracranial, intracranial, or congenital anomalies
  • Tympanocentesis, performed in the office, can serve both a diagnostic culture role and a therapeutic role

If not this — what else fits (8)

  • Benign nasopharyngeal masses are on the adult differential
  • Malignant tumors of the nasal cavity should be considered in adults with OME
  • Malignant tumors of the temporal bone are on the adult differential
  • Nasopharyngeal carcinoma is a differential to exclude, especially with unilateral adult effusion
  • Patulous Eustachian tube is on the adult differential list
  • Congenital craniofacial anomalies are on the pediatric differential
  • IgG subclass deficiencies are on the pediatric differential
  • Acute otitis media is a key differential in children

SourceStatPearls "Otitis Media With Effusion" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (ACTIVE OBSERVATION & AUTOINFLATION)

1st line
Adult dose and duration

Active observation for 3 months, then reassess hearing. Consider autoinflation (blowing up a balloon through the nostril) in a child old enough to engage with it. Refer for formal hearing assessment when OME is clinically suspected. x 3 months, then reassess

Paediatric dose

Reassess hearing after 3 months in bilateral OME with hearing loss. In children who are experiencing hearing difficulties that significantly affect day-to-day living, consider intervening earlier than the 3-month reassessment.

Dose source

Otitis Media With Effusion - StatPearls (NCBI Bookshelf NBK538293) - https://www.ncbi.nlm.nih.gov/books/NBK538293/: "For most children diagnosed with OME, conservative treatment with watchful waiting is recommended within the first 3 months of diagnosis." and "Autoinsufflation involves forcing air from the nose and throat into the middle ear to equalize pressure and promote drainage."

Why

Most glue ear resolves on its own. NG233 replaced CG60 in 2023 and offers no medicine for it - the treatment is time, a hearing test, and referral if it does not settle.

Cautions
  • Do NOT offer antibiotics for OME (NG233 1.5.2).
  • Do NOT offer oral or nasal corticosteroids for OME or the hearing loss it causes (NG233 1.5.3).
  • Do NOT offer antihistamines, montelukast, mucolytics, PPIs or anti-reflux drugs, or decongestants (NG233 1.5.4).
  • Persistent hearing loss past 3 months needs audiometry and ENT assessment - grommets are decided there, not here.
  • RED FLAG - An adult with OME on one side only is not a candidate for watchful waiting. Examine the head and neck properly, with nasopharyngoscopy and, where indicated, imaging - the question being malignancy (nasopharyngeal carcinoma above all) or other disease of the nose and nasopharynx.
2

SODIUM CHLORIDE

add-on - not a substitute

Formnasal

Adult dose and duration

Instil 1-2 sprays of 0.9% nasal saline spray into each nostril 3-4 times daily - As needed for nasal comfort

Paediatric dose

1-2 drops/sprays into each nostril before feeds or bedtime

Dose source

No labelled dose - isotonic saline irrigation, used as often as it helps

Why

Salt water for a blocked nose, nothing more. It does not clear the fluid behind the eardrum and does not shorten glue ear - NICE lists no medical treatment that does.

Cautions
  • This treats a blocked nose, not the effusion. Do not let it stand in for the hearing reassessment at 3 months.
  • Saline has no licensed dose - it is salt water. Use it as often as it clears the nose.
Egyptian brands
Egyptian brandManufacturerIndicative price
SOFIMER 0.9% MINI ISOTONIC NASAL SPRAY 30 ML> SOFICOPHARM170.00 EGP
SOFIMER 0.9% ISOTONIC NASAL SPRAY 100 ML> SOFICOPHARM290.00 EGP
POLYMER BABY ISOTONIC 0.9% NASAL SPRAY 100MLUK MEDICA LIMITED > WALFARM300.00 EGP
SODIUM CHLORIDE 0.9% (EL NASR) IRRIGAATION SOLN. 3000 MLEL NASR22.50 EGP
PHYSIOMER NORMAL JET NASAL SPRAY 135MLLABORATOIRE DE LA MER > STAR INTERNATIONAL COMPANY300.00 EGP
PHYSIOMER BABY MIST NASAL SPRAY 115MLLABORATOIRE DE LA MER > STAR INTERNATIONAL COMPANY400.00 EGP
UNIMER BABY 9% NASAL SOLUTION UNITDOSE 12*5MLLDPSA > WALFARM54.00 EGP
UNIMER BABY 9% NASAL SOLUTION UNITDOSE 50*5MLLDPSA > WALFARM150.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.