Introduction to serous otitis media (fluid in the ears)


Serous otitis media (SOM), also known as otitis media with effusion (OME), ear fluid , middle ear effusion (MEE), or secretory otitis media, is a condition in which fluid is found in the middle ear.

"Serous" refers to the type of fluid that collects inside the middle ear. Serous fluid is usually straw-colored (yellowish) fluid or mucus. In this case, Eustachian tube dysfunction occurs and the auditory tube cannot drain fluid as usual .

Risk factors for serous otitis media

The most common group of people at risk for serous otitis media are children. This usually goes away after a month. However, if the problem persists, your child's doctor may need to remove the fluid.

Common reasons that children are more likely to have fluid in the ear include differences in the Eustachian tube between children and adults. In children, the tube is shorter and more horizontal, which reduces the likelihood of fluid draining. Whereas in adults, the tube is longer and slopes more, allowing gravity to aid in the drainage of the middle ear.

In children, the fluid is most common in the middle ear between the ages of three and seven. Most children before school age have had at least one episode of middle ear fluid. Although it is more common in children, adults can still have problems with serous otitis media, but this is not as common. (If an adult has otitis media, they should have a nasopharyngeal test as this can sometimes be a sign of nasopharyngeal cancer.) Your risk can be affected by conditions your baby was born with, which can make your baby especially prone to fluid leakage. the nasopharynx. middle ear space, including:

  • Cleft palate
  • Down's Syndrome
  • Other congenital (present at birth) abnormalities of the facial bones

There are also many common illnesses or environmental conditions faced by children that can make them more prone to developing serous otitis media, including:

Symptoms of serous otitis media

Illustration by Brianna Gilmartin, Get Drug Information

You may not always experience symptoms of serous otitis media, which means that you may never know you have it if it is not noticed during the physical exam. However, sometimes there is enough fluid in the middle ear space and you may notice one or more of the following symptoms:

  • Pain
  • Hearing loss
  • Ear fullness
  • The child pulls the ear
  • The child has a change in behavior.

If you notice a lasting change in your child's behavior, it is usually best to have a doctor evaluate any ear problems, such as serous otitis media.

Serous otitis media versus ear infection

Keep in mind that serous otitis media is not an ear infection also known as acute otitis media. Although both have fluid in the middle ear space, the fluid in acute otitis media is infected, whereas in serous otitis media it is not.

An ear infection will reshape the eardrum, making it bulge toward the outside of the ear. With serous otitis media, the shape practically does not change. Your healthcare provider can pay attention to this when making a diagnosis.

You will also notice a difference in symptoms. An ear infection is often accompanied by a fever. The level of pain observed will also be different. You may experience pain with serous otitis media, but the pain is exacerbated by an ear infection.

Diagnosis of serous otitis media

Your healthcare provider can usually diagnose serous otitis media with tympanometry or pneumatic otoscopy.

Tympanometry is a test that measures pressure waves in response to the tympanic membrane. Because fluid behind the eardrum affects the eardrum's ability to move normally, tympanometry can be helpful in detecting fluid in the ear.

During pneumatic otoscopy, your healthcare provider will use an otoscope attached to a balloon syringe to assess how well the eardrum responds to pressure changes when the balloon syringe is squeezed. Fluid can also be determined by observing changes in the color of the tympanic membrane, which represent changes behind the tympanic membrane.


Serous otitis media usually lasts 2 to 12 weeks. If the fluid in the middle ear persists for more than three months, your healthcare provider will generally want to handle the fluid more aggressively. If fluid retention in the ear is not eliminated, it can lead to:

Treatment of serous otitis media

Serous otitis media usually disappears without any intervention. If the fluid behind the eardrum does not dissolve within three to six months, it is generally best to have your healthcare provider remove the fluid by surgically placing a tube in the ear .

Before installing the ear tubes, your doctor will also examine the back of your child's throat to determine if the adenoids may be blocking the Eustachian tube. If the adenoids are enlarged, your healthcare provider may recommend an adenoidectomy to avoid blockage of the auditory tube and further accumulation of fluid in the middle ear.

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