Otitis Media (with Effusion)

Family Doctor Logo


What is otitis media?

Otitis media is a generic term that refers to an inflammation of the middle ear without indicating a specific cause or origin of the condition. Specific otitis media conditions affecting the middle ear include acute otitis media and otitis media with effusion.

What is otitis media with effusion?

Otitis media with effusion means that there is fluid (effusion) in the middle ear. This can happen due to middle ear infection or just from eustachian tube dysfunction without infection. The middle ear is the space behind the eardrum. 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, unless it is caused by a painful infection or the fluid doesn’t go away.


What are the symptoms of ear infections?

The most common symptoms of an acute middle ear infection (otitis media) are ear pain and fever. If your child is too young to tell you what hurts, he or she may cry or pull at his or her ear. Your child may also be irritable or listless, have trouble hearing, or not feel like eating or sleeping.

What are the symptoms of otitis media with effusion?

Children who have otitis media with effusion may have the following symptoms:

  • 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)
  • Trouble sleeping
  • Irritability
  • Fever
  • Headache

Sometimes, otitis media with effusion does not cause any symptoms.

Causes & Risk Factors

What causes otitis media with effusion?

Fluid may build up in the middle ear for several reasons. When a child has a cold, the middle ear may produce fluid just like the nose does. A tube called the eustachian (say: “you-stay-shee-an”) connects the middle ear with the back of the nose. Normally, the eustachian tube lets fluid drain out of the middle ear. However, bacteria or viruses can infect the lining of your child’s eustachian tube causing it to swell. The adenoids (glands near the ear) can also become enlarged and block the eustachian tubes. It is also 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 actually wash bacteria from the throat right into the eustachian tubes and middle ear space, increasing risk for tube blockage and infection.

If the eustachian tubes are blocked, fluid in the ear cannot drain normally. If bacteria grow in the middle ear fluid, an effusion can become a middle ear infection (acute otitis). 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 the fluid stays in the middle ear.

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.


How is otitis media with effusion treated?

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 this time to see if fluid is still present.