Middle ear effusion

What is middle ear effusion?

The middle ear is the space behind the eardrum. Small amounts of fluid (liquid) are normally produced in the middle ear. Normally, this fluid drains out of the ear through the eustachian tube. The eustachian tube connects the middle ear to the back of the throat.

Fluid can cause problems when it builds up in the middle ear. This condition is called middle ear effusion, otitis media with effusion (OME), or serous otitis media.

Middle ear effusion is common, especially in children aged two years or younger. It is rare after age eight.

Ear anatomy

Signs and symptoms of middle ear effusion

Children with middle ear effusions do not have signs of an ear infection. This condition does not usually cause fever or pain in your child's ear. The most common symptoms are:

• hearing problems, such as turning the volume on the television too high or often asking "What?"
• unresponsiveness or inattentiveness
• slow learning
• slow speech development

Causes of middle ear effusion

Middle ear effusion happens when the eustachian tube is blocked and/or the lining of the middle ear produces too much fluid. This causes fluid to build up in the middle ear.

Middle ear effusion often happens after a viral respiratory infection or an ear infection. Middle ear effusions usually resolve on their own within a few weeks of infection, but about 10% of children will still have fluid in the ear three months after the infection clears up.

In children with a cleft palate, the eustachian tubes do not open properly when swallowing, so fluid cannot drain through them. This means that many children with cleft palate will develop middle ear effusion.

How a health-care provider can help your child with middle ear effusion

Your child's health-care provider will examine your child's ears with an instrument called an otoscope. An otoscope has a magnifying lens with a light so the ear drum can be seen. They may also send your child for a hearing test. If your child has a middle ear effusion that is affecting their hearing and persists for more than three months, your child may be referred to an ear, nose, and throat specialist (otolaryngologist).

Antibiotics, antihistamines, decongestants and steroid nasal sprays are not recommended to treat middle ear effusions.

Surgical treatment for middle ear effusion

If your child has hearing loss and a persistent middle ear effusion that is not improving on its own, your child may need surgery to drain the fluid.

Tube placement

The most common surgery for middle ear effusion is the insertion of tubes in your child's ears. A surgeon will put your child under general anesthesia in order to put a small drainage tube through your child's eardrum. The tube will help drain the fluid. Your child's hearing should improve right away. Special earplugs may need to be worn to prevent water from going into the ears.

Recovery

Most children will recover from complications from middle ear fluid on their own. As your child grows, the eustachian tube will grow, and the fluid will have more space to drain from the middle ear. Children do not usually get middle ear effusion after age eight.

Complications of middle ear effusion

The fluid build-up can temporarily affect a child's hearing. If middle ear effusion is properly treated and monitored, it will rarely do lasting damage to a child's hearing. However, the hearing loss from a middle ear effusion may contribute to speech and language development, especially in children with other conditions that affect hearing or speech.

When to seek medical assistance

Talk to your child’s health-care provider if:

• your child's speech development is delayed
• your child does not respond to sudden loud noises
• you are concerned about their hearing or speech