Serous Otitis Media

Fluid in the Ears

Ear drum with fluid behind it
Ear drum with fluid behind it. "Adult Serous Otitis Media" by Michael Hake MD - Own work. Licensed under CC BY-SA 4.0 via Wikimedia Commons -

Serous Otitis Media

Also known as: otitis media with effusion (OME), fluid in the ear, middle ear effusion (MEE), or secretory otitis media

Serous otitis media (SOM) is a condition in which fluid resides in the middle ear. "Serous" refers to the type of fluid that is collecting inside the middle ear. Serous fluid is usually straw (yellowish) colored liquid or mucus. In this case, there is eustachian tube, or auditory tube, dysfunction that is not draining the fluid as it normally should.

Risk Factors for Serous Otitis Media

The most common group of people at risk for getting serous otitis media are children. Particularly newborns, where approximately 6 out of 10 newborns may fail their hearing test due to fluid in the ear. This will usually resolve in a month, however if it is unresolved, your child's doctor may need to help remove the fluid.

Common reasons for this includes the difference in the eustachian tube between children and adults. In children, the tube is both shorter and more level, making it less likely to drain fluid. Whereas in adults, the tube is longer and has more of a sloped angle allowing gravity to assist in draining the middle ear. Children are most likely to have fluid in the middle ear between 6 and 11 months, and risk decreases as your child gets older. Most children will have had at least one episode of fluid in the middle ear before the reach school-age.

While it is most prevalent in children, adults can still have issues with serous otitis media, however it is not as common.

Risk can be impacted by disorders that your child is born with that can make them particularly prone to getting fluid in the middle ear space including:

  • developmental disorders
  • Down syndrome
  • speech and other language delays
  • hearing disorders (not related to the fluid)
  • blindness
  • other congenital (present at birth) facial bone abnormalities

However there are also many common problems that children face that can also make them prone to developing serous otitis media including:

Difference Between an Ear Infection and Serous Otitis Media

Be aware that serous otitis media is not an ear infection, otherwise known as acute otitis media. While both have have fluid in the middle ear space, acute otitis media's fluid is infected, where as serous otitis media's fluids is not infected fluid. When you doctor is doing an ear exam with an otoscope, an ear infection will change the shape of the ear drum, making it bulge toward the outside of the ear. With serous otitis media, the shape isn't really changed.

You will also notice a difference in symptoms. an ear infection will almost always have a fever associated with it.

The level of pain noticed will also be different. While you can experience pain with serous otitis media, the level of pain is worse with an ear infection.

Diagnosing Serous Otitis Media

Your doctor can diagnose serous otitis media normally by using either: tympanometry or pneumatic otoscopy. Tympanometry is test that measures the ear drums response to sound waves. Since fluid behind the ear drum will affect the ability of the ear drum to move normally, tympanometry can be useful in determining fluid in the ear. However pneumatic otoscopy is more accurate in diagnosing fluid in the ear. The doctor will use an otoscope that has a bulb syringe attached which allows them to evaluate how well the ear drum reacts to the pressure change when the bulb syringe is squeezed. Fluid can also be determined by observing for color changes of the ear drum, representing changes behind the ear drum.

How Long Will Serous Otitis Media Last?

Serous otitis media usually will last around 3 months. If fluid in the middle ear persists longer than 3 months, your doctor will usually want to treat the fluid more aggressively. Failure to correct prolonged fluid in the ear may result in:

Symptoms Related to Serous Otitis Media

You may not always experience symptoms with serous otitis media, which means that you may not ever know that you have it unless it is noticed during a doctor's physical exam. However, sometimes there is enough fluid in the middle ear space that you will notice one or more of the following symptoms:

  • pain
  • hearing loss
  • ear fullness
  • child pulling at their ear
  • child has a change in behavior

Young children may be difficult for you to tell that there is an issue with their ears, so if you notice a prolonged behavior change, it is usually best to have a doctor evaluate them for any problems with their ears like serous otitis media

Treatment of Serous Otitis Media

Serous otitis media will usually resolve without any intervention within 3 months. If allergies are a suspected reason, then your doctor will usually prescribe an antihistamine (like Zyrtec or Allegra) to be tried during the 3 month monitoring period. If the fluid behind the ear drum is not resolved within 3 months, it is generally best for your doctor to remove the fluid by surgically placing an ear tube.

Prior to placing the ear tubes, your doctor will also look in the back of your child's throat to determine if the adenoids may be blocking the eustachian tube. If the adenoids are enlarged, your doctor may recommend an adenoidectomy to prevent blockage of the eustachian tube from causing further fluid collecting in the middle ear.


Casselbrandt, M.L. & Mandel, E.M. (2015). Cummings Otolaryngology, 6th ed.: Acute Otitis Media and Otitis Media with Effusion. Saunders:Elsevier.

ExitCare. (2015). Patient Education: Serous Otitis Media. Accessed on 2/26/2016 from (subsription required)

O’Connor, S.S., Coggins, R., Gagnon, L., Rosenfeld, R.M., Shin, J.J. & Walsh, S.A. (2016). Otolaryngol Head Neck Surg. 154(2):215-225. doi: 10.1177/0194599815624409

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