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Key Features

  • Middle ear effusion with decreased tympanic membrane (TM) mobility

  • No signs or symptoms of acute inflammation

  • May precede or follow an episode of AOM

Clinical Findings

  • Presence of fluid in the middle ear space without signs or symptoms of acute inflammation

  • Acute pain is not characteristic but there may be some discomfort


  • A retracted or neutral TM with decreased mobility is seen on pneumatic otoscopy

  • The TM may be opacified or may have a whitish or amber discoloration


  • An audiology evaluation should be performed after approximately 3 months of continuous bilateral effusion in children younger than 3 years

  • Children with hearing loss or speech delay should be referred to an otolaryngologist for possible tympanostomy tube placement

  • Absolute indications for tympanostomy tubes include

    • Hearing loss greater than 40 dB

    • TM retraction pockets

    • Ossicular erosion

    • Adhesive atelectasis

    • Cholesteatoma

  • Antibiotics, antihistamines, and corticosteroids have not been shown to be useful

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