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 (say: you-STAY-shun) 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

This condition does not usually cause 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 cold or an ear infection. 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 doctor can help your child with middle ear effusion

Your child's doctor will examine your child's ears with a special viewing instrument called an otoscope. If necessary, your child will be referred to an ear, nose, and throat specialist (otolaryngologist). This specialist may suggest hearing tests or other tests for your child.

A follow-up visit about three months later will determine whether your child needs surgery to drain the fluid, or if it has drained by itself.

Surgical treatment for middle ear effusion

If your child's condition 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 anaesthesia 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, there is evidence that if the condition goes on too long in early childhood, it can affect how the child learns to listen and talk. This may lead to:

• problems with verbal and written language
• behavioural issues such as hyperactivity and inattention

These issues may continue into the later teen years.

When to seek medical assistance

Make an appointment with your baby or child's doctor if:

• your baby or child does not respond to sudden loud noises
• your baby does not respond to their name by the age of 12 months
• your child develops an earache
• your child's speech development is delayed
• you have other questions or concerns