Fluid in the ear, also called serous otitis media Otitis media (SOM), or otitis media with effusion (OME), is a buildup of fluid behind the eardrum that can occur in any condition in which it is altered ear tube.
The ear tube allows fluid to drain from the ear to the back of the throat. If the ear tube becomes blocked, the fluid will enter the middle ear space. Your health care providers call this liquid spill. In addition to ear infections, common colds and allergies can often cause fluid to form in the ear if inflammation or mucosa prevent the ear tube from draining.
Find out what else can cause the buildup, how to prevent it, and how to diagnose and treat the condition.
Anyone can have fluid in their ears, but it is much more common in children because of the anatomy of their ear tube, which is smaller in diameter and more horizontal than an adult’s ear tube.
Each year, about 2.2 million cases of otitis media with effusion are recorded in the United States, and about 90 out of 100 children develop fluid in their ears sometime before they are 5 to 6 years old.
All cases of fluid in the ear are caused by some form hearing tube dysfunctions, which prevents proper drainage of the Eustachian tube. Common causes of fluid formation in the ear in both adults and children include:
- Any type of stagnation, by cold virus, similar infection or even pregnancy
- Enlarged sinus tissue, nasal polyps, tonsils and adenoids, or other neoplasms that block the ear tube (usually caused by chronic sinusitis)
- Exposure to chemical irritants, especially cigarette smoke.
- Damage to the auditory tube as a result of radiation in head and neck cancer or previous surgeries that may dissect the auditory tube (rarely)
- Barotrauma of the ears (rapid changes in ambient air pressure, such as flying in an airplane or diving)
- Oral abnormalities that may be related to down syndrome or cleft palate
Symptoms of fluid in the ears can vary in severity in individuals. In young children, this condition is often called asymptomatic, although children this age are more likely to simply not be able to express any discomfort. In the absence of severe ear pain, most symptoms go unnoticed by caregivers.
For most adults, fluid symptoms in the middle ear may be imperceptible, but some adults report persistent ear pain and debilitating symptoms. Some adults and older children who have had persistent problems with chronic fluid in their ears can sometimes determine when the fluid has accumulated again and need treatment. In general, symptoms of fluid in the ears may include:
- The feeling that “covered”ears
- Increased ear pain by changing height and inability to “clap” ears
- Ringing in the ears (tinnitus)
- Hearing loss or the feeling that sounds are muted
- Feeling of fullness in the ears
- Loss of balance or dizzy (rarely)
- Behavioral problems
- Poor school performance associated with hearing loss
There are several conditions that cause symptoms similar to fluid in the ear or that may be present at the same time as fluid in the ear, including:
- Middle ear infections
- Ear drainage
- Ear barotrauma
- Ear pain
Because fluid in the ear is often asymptomatic, especially in children, it is often not diagnosed. If your child has fluid symptoms in the ear, it is best to take it to a doctor, pediatrician, or otolaryngologist (specialist in ears, nose, throat or ENT). A specialist may have access to more advanced diagnostic equipment, but more importantly, their expertise is essential in recognizing subtle clues that may mean you have fluid in your ears.
The best method to diagnose fluid in the ear is to examine the ear with an otoscope or otomicroscope. Your healthcare provider will likely use an otoscope, as they are more common because of the cost, although an otomicroscope can provide a more accurate diagnosis.
Evaluation of the ear with an otoscope is very simple and involves pulling the ear and inserting the tip of the otoscope into the ear. This allows a medical professional to view the eardrum (eardrum). Experienced doctors may see the level of fluid behind the eardrum, bladder, or that the eardrum is still.
Unfortunately, this is not always so clear, and the only sign of fluid in the ear may be a slight retraction of the eardrum or a slightly abnormal coloring. For this reason, a qualified doctor is needed to diagnose fluid in the ear.
Fluid in the ear can be confirmed by another test called tympanometry. This test has some similarities to the test that uses an otoscope, because the ear will be removed and the tip of the instrument, also called a mirror, will be placed on the outside of the ear canal. Your child (or you, if you are a patient) should try to stay very calm during this test and avoid talking or swallowing whenever possible.
The instrument will measure the pressure inside the ear and then beep. The eardrum will reflect a certain amount of sound again in tympanometer, which is shown in a graph called tympanogram. If there is fluid in the ear, the eardrum will harden and reflect an abnormal amount of sound.
In general, it is not necessary to treat the fluid in the ears. The liquid usually drains on its own within a few weeks. However, if this does not happen, treatment will depend on several factors.
- If the fluid is present for 6 weeks, treatment may include a hearing test, antibiotic treatment, or additional follow-up.
- If fluid is present after 12 weeks, a hearing test should be done. If there is significant hearing loss, the doctor may consider using antibiotics or putting tubes in the ears.
- If fluid is still present after 4 to 6 months, the hearing tubes may need to be surgically placed, even if you do not have hearing loss.
- Adenoids may also be needed for removal if they are large and cause significant blockage of the Eustachian tube.
Fluid in the ears may be present with or without active infection. Antibiotics are useless unless there is a current ear infection and they are not used. Precisely while antihistamines are helpful in preventing chronic sinusitis that can affect the drainage of the ear tube, antihistamines are not recommended to treat fluid in the ear.
High-risk children, including those with developmental delays, may need treatment earlier. For kids who don’t need treatment, it’s best to control symptoms and wait for the fluid to go away on its own. Even among children who require surgery, a full recovery is almost always achieved.
These steps can be taken to prevent fluid from entering the ear:
- Avoid cigarette smoke.
- Avoid known allergens.
- If your child is in daycare, consider taking him out or moving to a smaller daycare if he often has fluid in his ears.
- Wash your child’s hands and toys often.
- Avoid overuse of antibiotics.
- Encourage breastfeeding if possible, even for a few weeks. Breastfed babies get sick less often and are less likely to get ear infections even years later.
- Stay up to date with the latest vaccine data. The pneumococcal vaccine (Prevnar) helps prevent the most common type of ear infections, and the flu vaccine may also help.
Contrary to popular belief, water ingress into the ears of a child or toddler will not cause severe otitis media. Children who swim frequently and don’t dry out enough may have a swimmer’s ear, but this is a completely different condition.
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Fluid in the ear is a common problem, especially for babies at a young age. Whether you are an adult or a child, the fluid in your ear is likely to dissolve without treatment.
However, if your symptoms persist for more than six weeks or cause significant symptoms, you should consult your health care provider. Prolonged, untreated discharge of fluid into the ear can affect your quality of life and performance at school or work.
Frequently asked questions
The fluid in the ear can take up to three months to clean itself. if you continue to have problems, your doctor may prescribe antibiotics and look for an underlying problem that may require further treatment.
Pulling the earlobe and moving your head, you should help the water out of the ear canal, or you can create a vacuum with the palm of your hand. Using a solution consisting of 50% rubbing alcohol and 50% white vinegar after swimming can also dry the ear canal and prevent infections caused by the swimmer’s ear.
Earwax coming out of your ear is normal. It can be white, yellow or brown and can be liquid. However, only a small amount of fluid should come out of the ear. If the discharge continues or if you see signs of blood or pus, it may indicate a ruptured eardrum. this is abnormal and you should see your health care provider.