Overview of Serous Otitis Media (Fluid in the Ears)

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Serous otitis media (SOM) is when liquid or mucus in the middle ear blocks the eustachian tube, a channel that would otherwise be able to drain fluid and equalize pressure in the ear. The fluid build-up can cause discomfort or hearing loss. If it doesn't resolve, ear tubes may be needed.

SOM is also called otitis media with effusion (OME), fluid in the ear, middle ear effusion (MEE), or secretory otitis media.

Risk Factors for Serous Otitis Media

The most common group of people at risk of getting serous otitis media are children. This will usually resolve in a month. If it is unresolved, however, your child's healthcare provider may need to help remove the fluid.

Common reasons that children are more likely to get fluid in the ear 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 three to seven years of age. Most children will have had at least one episode of fluid in the middle ear before they reach school-age. While it is most prevalent in children, adults can still have issues with serous otitis media, it's just not as common. (If an adult has otitis media, they should have the nasopharynx checked, as sometimes this can be a sign of nasopharynx cancer.) 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:

  • Cleft palate
  • Down syndrome
  • Other congenital (present at birth) facial bone abnormalities

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

Symptoms of Serous Otitis Media

symptoms of serous otitis media
Illustration by Brianna Gilmartin, Verywell

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 healthcare provider'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

If you notice a prolonged behavior change in your child, it is usually best to have a healthcare provider evaluate them for any problems with their ears like serous otitis media

Serous Otitis Media vs. Ear Infection

Be aware that serous otitis media is not an ear infection, otherwise known as acute otitis media. While both have fluid in the middle ear space, fluid with acute otitis media is infected, whereas that is not the case with serous otitis media.

An ear infection will change the shape of the eardrum, making it bulge toward the outside of the ear. With serous otitis media, the shape isn't really changed. Your healthcare provider can look for this when making a diagnosis.

You will also notice a difference in symptoms. An ear infection will often 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 healthcare provider can diagnose serous otitis media normally by using either: tympanometry or pneumatic otoscopy.

Tympanometry is a test that measures the eardrum's response pressure waves. Since fluid behind the eardrum will affect the ability of the eardrum to move normally, tympanometry can be useful in determining fluid in the ear.

During pneumatic otoscopy, the healthcare provider will use an otoscope that has a bulb syringe attached, which allows them to evaluate how well the eardrum reacts to the pressure change when the bulb syringe is squeezed. Fluid can also be determined by observing for color changes of the eardrum, representing changes behind the eardrum.


Serous otitis media usually will last for around two to 12 weeks. If the fluid in the middle ear persists longer than three months, your healthcare provider will usually want to treat the fluid more aggressively. Failure to correct prolonged fluid in the ear may result in:

Treatment of Serous Otitis Media

Serous otitis media will usually resolve without any intervention. If the fluid behind the eardrum is not resolved within three to six months, it is generally best for your healthcare provider to remove the fluid by surgically placing an ear tube.

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

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Kristin Hayes, RN
Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children.