Often resolves spontaneously within 3 months. For persistent symptoms like impaired hearing, autoinflation with a nasal balloon can help drain fluid by keeping the eustachian tube open, performed 2–3 times daily until resolution. Steroids, antibiotics, and decongestants are not recommended, and surgical intervention may be considered in rare severe or prolonged cases.
January 15, 2025

Glue Ear (Otitis Media with Effusion): What to Do According to the Experts

Evidence-Based Over-The-Counter Guide

William Shen

William Shen

Co-founder & CPO

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Glue ear, or otitis media with effusion (OME), involves fluid accumulation in the middle ear, behind the eardrum, without infection.

This guide is based on the American Academy of Otolaryngology 2016 practice guidelines for doctors, which recommends against using steroids, antihistamines, or antihistamines for OME.

First-line recommendations:

  • Watchful waiting: Spontaneous resolution occurs in most cases within 3 months. Caregivers can monitor using an at-home pocket otoscope.

Second-line recommendations: 

  • Autoinflation device: Can be considered if symptoms such as impaired hearing occurs. Increasing nasal pressure with a nasal balloon can help keep the eustachian tube open and allow the fluid to drain naturally down the back of the throat. This is a generally safe procedure; do not blow too hard to avoid eardrum damage. 

Autoinflation procedure: See NHS England guide or manufacturer instruction for details. In summary, use 3 times a day for the first week and twice a day after 1 week until resolution. You may experience a “clicking” sensation, slight discomfort or movement in your ears. 

  • For the first use please stretch the balloon. Connect the balloon onto the nose piece.

  • Hold the round part of the nose piece firmly against the right nostril with the right hand.

  • Press the left nostril closed with the left hand.

  • Inhale deeply, close the mouth and inflate the balloon until it is the size of a grapefruit, by blowing through the nostril.

  • Repeat the procedure with the left nostril. 

Not recommended:

  • Steroids, antibiotics, antihistamines, anti-reflux therapies, and decongestants are not routinely indicated for the treatment of OME as evidence is sparse

Professional intervention:

  • Small surgical procedures may be needed if hearing loss, damage to eardrum, or developmental disorders (in children) occur. Ask your doctor.

Citations:

Rosenfeld RM, Shin JJ, Schwartz SR et al. Clinical practice guideline: Otitis media with effusion. Otolaryngol Head Neck Surg. 2016; 154(1): p.S1-S41. doi: 10.1177/0194599815623467

Perera R, Glasziou PP, Heneghan CJ, McLellan J, Williamson I. Autoinflation for hearing loss associated with otitis media with effusion. Cochrane Database Syst Rev. 2013. doi: 10.1002/14651858.cd006285.pub2

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