Ear: Middle Ear Fluid

What is middle ear fluid?

Fluid is normally produced in the middle ear (the space behind the eardrum) in small amounts. Usually the fluid drains out of the ear though the eustachian tube into the back of the nose. Ear fluid can cause a problem when it builds up in the middle ear. This condition is called otitis media with effusion, or secretory otitis media.

What causes ear fluid to build up in the middle ear?

After an ear infection, the eustachian tube may be temporarily blocked and fluid will build up in the middle ear space instead of draining out normally. After taking antibiotics for the ear infection, your child may still have fluid left in the middle ear, but it is no longer infected fluid.

If there is fluid in the middle ear, your child will probably have:

• A full, congested sensation in the ear
• Mildly reduced hearing (temporary)

There is no earache or fever.

How long will it last?

Because the middle ear fluid clears up by itself in 90% of children, no treatment is needed for most children. The fluid will slowly go away.

• By 1 month, 50% of children will still have fluid.
• By 2 months, 20% of children will still have fluid.
• By 3 months, only 10% of children will still have fluid.

If there is still fluid in the ear after 3 to 4 months, your child will probably need ventilation tubes or special medicines because the fluid will most likely not clear up by itself.

What is the treatment?

1. Help your child with temporary hearing loss

   Most children with middle ear fluid have a mild hearing loss (20 to 30 dB). If your child temporarily loses hearing before age 2, it can interfere with normal speech development. Although the fluid will probably clear in 1 to 2 months, help your child deal with limited hearing. Keep in mind that most children's speech will catch up following a brief period of incomplete hearing.

   When you talk with your child:

   • Get close to your child, get eye contact, and get his full attention. Occasionally check that he understands what you have said.
   • Speak in a louder voice than you normally use. A common mistake is to assume your child is ignoring you when actually he doesn't hear you.
   • Reduce any background noise from radio or television while talking with your child.

   If your child goes to school, be sure he sits in front near the teacher. Middle ear fluid interferes with the ability to hear in a crowd or classroom.

2. Restrictions

   Your child doesn't have any restrictions because of ear fluid. Your child can go outside and does not need to cover the ears. Swimming is permitted unless there is a perforation (tear) in the eardrum, ear tubes, or drainage from the ear. Air travel or a trip to the mountains is safe; just have your child swallow fluids, suck on a pacifier, or chew gum during descent.

3. Medicines

   Your child doesn't need any medicines unless he has allergies or an ear infection. Antibiotics do not help to clear middle ear fluid.

4. Ear recheck

   Your child needs to be checked again to be sure the ear fluid doesn't last longer than 3 months and that it doesn't affect speech development.

Call your child's healthcare provider during office hours if:

• Your child develops an earache.
• Your child's speech development is delayed.
• You have other questions or concerns.