Otitis Media (with Effusion)

Overview

What is otitis media with effusion?

Otitis media is a generic term that refers to an inflammation of the middle ear. The middle ear is the space behind the eardrum. Otitis media with effusion means there is fluid (effusion) in the middle ear, without an infection.

Fluid in the middle ear can have few symptoms, especially if it develops slowly. It almost always goes away on its own in a few weeks to a few months. So, this kind of ear problem doesn’t usually need to be treated with antibiotics. Your doctor may decide to treat it if it causes a painful infection or if the fluid doesn’t go away.

Otitis media with effusion is most common in young children, age 2 and under. But it can affect people of any age.

Symptoms

Children who have otitis media with effusion may not have any symptoms. Usually they don’t act sick. They could experience the following:

  • A feeling of fullness in the ear.
  • Muffled hearing.
  • Fluid that drains from the ears (if the eardrum has ruptured).
  • Some pain inside the ear (if your child is too young to speak and tell you his or her ear hurts, he or she may tug at the ear often).

If your child’s otitis media with effusion develops into an infection, he or she may have other symptoms. These include:

  • Pain in the ear (crying or pulling at the ear for very young children).
  • Fever.
  • Irritability.
  • Listlessness.
  • Trouble hearing.
  • Not feeling like eating or sleeping.

Causes & Risk Factors

The Eustachian tube connects the middle ear with the back of the throat. Normally, this tube lets fluid drain out of the middle ear. But sometimes the Eustachian tube swells. It can become partially or completely blocked. This can cause fluid to build up in the middle ear.

The following may cause the Eustachian tube to swell:

  • Allergies.
  • Irritants, such as cigarette smoke.
  • Respiratory infections.
  • Enlarged adenoids (glands near the ear).
  • Drinking while lying on the back (bottle-fed babies).
  • A sudden increase in air pressure (descending in an airplane or driving on a mountain).

If the Eustachian tubes are blocked, fluid in the ear cannot drain normally. If bacteria grow in the middle ear fluid, an effusion can turn into a middle ear infection (acute otitis media). This will usually increase pressure behind the eardrum and cause a lot of pain. The eardrum will become red and bulging. If this happens, your child may need to be treated with antibiotics. Children who have frequent ear infections can also develop otitis media with effusion after their infection is gone, if fluid stays in the middle ear.

It is not a good idea to let your baby fall asleep with a bottle or to leave a bottle in the crib. Drinking while lying down can wash bacteria from the throat right into the Eustachian tubes and middle ear space. This increases the risk for tube blockage and infection.

Diagnosis

How is otitis media with effusion diagnosed?

If you think your child may have otitis media with effusion, make an appointment your child’s doctor. He or she will look in your child’s ears. They will look at the eardrum for signs that there may be fluid behind it. They may order a test called tympanometry. It can diagnose otitis media with effusion. It can also help tell the amount and thickness of the fluid that is trapped. They may also want to do a hearing test on your child.

Prevention

Can otitis media with effusion be prevented or avoided?

The best ways to prevent fluid build-up in the ears are the same as preventing ear infections:

  • Wash your child’s hands and toys often.
  • Avoid pacifiers.
  • Breastfeed your baby.
  • If you bottle-feed your baby, hold him or her in an upright, seated position when feeding them.
  • Keep your child away from cigarette smoke.
  • Make sure your child’s vaccinations are up to date.

Treatment

If your child is older than 6 months of age and only has mild symptoms, the best treatment is to let the fluid go away on its own. You can give your child an over-the-counter pain reliever, such as acetaminophen, (one brand: Children’s Tylenol) if he or she is uncomfortable. A warm, moist cloth placed over the ear may also help.

Usually the fluid goes away in 2 to 3 months, and hearing returns to normal. Your doctor may want to check your child again at some point to see if fluid is still present. If it is, he or she may give your child antibiotics.

One treatment your doctor may suggest is a nasal balloon. A nasal balloon can help clear the fluid from the middle ear. You can easily use a nasal balloon at home. Your child will simply insert the balloon nozzle in one nostril while blocking the other nostril with a finger. Then, he or she will inflate the balloon with their nose.

If the fluid does not go away after a certain amount of time and treatment, your child may need ear tubes. These small tubes are inserted through the ear drum. They allow the doctor to suction out the fluid behind the ear. They also allow air to get into the middle ear, which helps prevent fluid build-up. Any hearing loss experienced by your child should be restored after the fluid is drained.

FDA Warning

The. U.S. Food and Drug Administration (FDA) advise against the use of ear candles. Ear candles can cause serious injuries and there is no evidence to support their effectiveness. For more information, please visit the FDA Web site.

Living with otitis media with effusion

Most cases of otitis media with effusion go away on their own in a few weeks or months. Treatment may speed up the process. Most children don’t have any long-term effects to their ears, their hearing, or their speaking ability. This is the case even if they had fluid build-up in their ears for a long time.

In a few cases, otitis media with effusion could lead to longer term issues. These include:

  • Recurrent ear infections.
  • Problems with speech and language development.
  • Permanent hearing loss.

But most children recover quickly and have no long-term effects.

Questions to ask your doctor

  • What caused fluid to build up in my or my child’s ear?
  • Do I or my child need treatment?
  • What kind of treatment will be best for me or my child?
  • Does my child need ear tubes?

Resources