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For further information, see CMDT Part 8-04: Diseases of the Eustachian Tube

Key Features

Essentials of Diagnosis

  • Eustachian tube obstruction is the underlying cause

  • Resultant negative pressure causes transudation of fluid into the middle ear

General Considerations

  • Especially common in children because their eustachian tubes are narrower and more horizontal in orientation than in adults

  • Less common in adults, in whom it usually occurs

    • After an upper respiratory tract infection

    • With barotrauma

    • With chronic allergic rhinitis

  • In an adult with persistent unilateral serous otitis media, nasopharyngeal carcinoma must be excluded

Clinical Findings

  • Tympanic membrane is dull and hypomobile

  • Occasionally accompanied by air bubbles in the middle ear and conductive hearing loss


  • Clinical



  • Short course of oral corticosteroids (eg, prednisone, 40 mg orally daily for 7 days)

  • Oral antibiotics (eg, amoxicillin, 250 mg three times daily for 7 days)

  • Combination of oral corticosteroids and antibiotics

  • The role of these regimens remains controversial; they are probably of little lasting benefit


  • When medication fails to bring relief after several months, a ventilating tube placed through the tympanic membrane may restore hearing and alleviate the sense of aural fullness


When to Refer

  • For persistent or recurrent symptoms


Vanneste  P  et al. Otitis media with effusion in children: pathophysiology, diagnosis, and treatment. A review. J Otol. 2019;14:33.
[PubMed: 31223299]  

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