# Otitis Media with Effusion (Glue ear) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - No drug therapy in primary care (Active Observation & Autoinflation) - Sodium chloride — nasal ## Complete treatment card ```text OTITIS MEDIA WITH EFFUSION (GLUE EAR) 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 Review status: REVIEWED against 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) (2026-08) 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 Source StatPearls "Otitis Media With Effusion" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (ACTIVE OBSERVATION & AUTOINFLATION)[1st line] Adult 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 Peds 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. 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. Caution 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] Adult Instil 1-2 sprays of 0.9% nasal saline spray into each nostril 3-4 times daily - As needed for nasal comfort Peds 1-2 drops/sprays into each nostril before feeds or bedtime 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. Caution 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. Egypt SOFIMER 0.9% MINI ISOTONIC NASAL SPRAY 30 ML > SOFICOPHARM 170.00 EGP SOFIMER 0.9% ISOTONIC NASAL SPRAY 100 ML > SOFICOPHARM 290.00 EGP POLYMER BABY ISOTONIC 0.9% NASAL SPRAY 100ML UK MEDICA LIMITED > WALFARM 300.00 EGP SODIUM CHLORIDE 0.9% (EL NASR) IRRIGAATION SOLN. 3000 ML EL NASR 22.50 EGP PHYSIOMER NORMAL JET NASAL SPRAY 135ML LABORATOIRE DE LA MER > STAR INTE... 300.00 EGP PHYSIOMER BABY MIST NASAL SPRAY 115ML LABORATOIRE DE LA MER > STAR INTER... 400.00 EGP UNIMER BABY 9% NASAL SOLUTION UNITDOSE 12*5ML LDPSA > WALFARM 54.00 EGP UNIMER BABY 9% NASAL SOLUTION UNITDOSE 50*5ML LDPSA > WALFARM 150.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)