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Otitis Media with Effusion (Middle Ear Fluid)

My child has had fluid in his ears...What is that and why is it there?

Fluid in the ears, without signs of infection, is very common and is called otitis media with effusion (OME).  There are several kinds of fluid, ranging from thin and watery, to very thick and viscous (called a glue ear).   Fluid may be present for any of several reasons.  In young children, the most common reason is probably a recent (within 2 months) infection in the ears, sinuses, or nose.  Most cases of acute otitis media (fluid and infection in the ear) are followed by episodes of otitis media with effusion (OME).  Not surprising, in children with frequent bouts of ear infections (acute otitis media), they may not completely clear the fluid before becoming infected again.  Other causes of OME include chronic eustachian tube dysfunction - as seen in cleft palate patients (among others) and adenoid problems (enlargement or chronic infection).  Very rare causes include abnormal leakage of brain fluid (cerebrospinal fluid), or fluid from cysts or tumors.

Examples of Otitis Media with Effusion

thin watery yellow middle ear fluid (4201 bytes) mucoid middle ear fluid (3869 bytes) severe retraction and yellow "glue ear" (4408 bytes)
Thin watery fluid...often clears by itself...especially when there is air in the middle ear...as seen in the ear above. Thicker mucoid fluid, sometimes seen with a low grade infection. This may improve on antibiotics, or may need tubes. The ear drum above is severely retracted (sucked in)...and the fluid is so thick that it is hard to suction out.   This one likely needs tubes.
Thin watery fluid (10404 bytes) Thicker middle ear fluid (18705 bytes) fluid from a chronic "glue ear"  (10116 bytes)

 

How is ear fluid (otitis media with effusion) treated?

Many cases of OME need no treatment; they resolve by themselves.   This is especially appropriate in the asymptomatic child with little hearing loss, normal speech and language development, and a history of having normal ears in the recent past.  Children with multiple infections might be moved away from other children (out of daycare).  Anitbiotics probably have a small (and probably temporary) beneficial effect...for a minority of children (since there often is no infection).  Steroids might help some children, at least temporarily, but are generally not recommended...because of side effects and lack of conclusive evidence about effectiveness.  Antihistamines and/or decongestants are often recommended but have, in general proven NOT to be of benefit.  Likewise, allergic management is vigorously defended by some practitioners; but the data about effectiveness is not convincing.  Holistic, nutritional, chiropractic, "candle-ing", garlic, and other "natural" remedies work at least as well as placebo (which is not too bad)...but are severely lacking in data or rationale.  Surgical treatments such as tube insertion and/or adenoidectomy are generally recommended for long-standing OME (greater than 3-4 months), or for those cases with unusually severe symptomatology or associated problems (e.g., speech and language delay).

Contact Us

Children' s Memorial Hermann Hospital
6411 Fannin
Houston, Texas 77030

Phone: (713) 222-2273

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This information, although based on a thorough knowledge and careful review of current medical literature, is the opinion of doctors at The University of Texas Medical School and is presented to inform you about surgical conditions. It is not meant to contradict any information you may receive from your personal physician and should not be used to make decisions about surgical treatment. If you have any questions about the information above or your child's care, please contact our doctors.