Middle Ear Fluid and Your Child

The middle ear is the space, usually filled with air, behind the eardrum. When a child has middle ear fluid (otitis media with effusion), it means that a watery or mucous-like fluid has collected in the middle ear. Otitis media means middle ear inflammation, and effusion means fluid.

Middle ear fluid is not the same as an ear infection. An ear infection occurs when middle ear fluid is infected with viruses, bacteria or both, often during a cold. Children with middle ear fluid have no signs or symptoms of infection. Most children don’t have fever or severe pain, but may have mild discomfort or trouble hearing. About 90 percent of children get middle ear fluid at some time before age 5.

There is no one cause for middle ear fluid. Often your pediatrician may not know the cause. Middle ear fluid could be caused by:

A past ear infection
A cold or flu
Blockage of the eustachian tube (a small tube that connects the middle ear to the back of the nose)

You can help your pediatrician find the cause of your child’s middle ear fluid. Just write down your child’s name, pediatrician’s name and number, date and type of ear problem or infection, treatment, and results. These clues and can lead to a cause of the fluid.

Many healthy children with middle ear fluid have little or no problems. They often get better on their own. Often middle ear fluid is found at a regular checkup. Ear discomfort, if present, is usually mild. Your child may be irritable, rub his ears or have trouble sleeping. Other symptoms include hearing loss, changes in behavior, loss of balance, clumsiness and repeated ear infections. You may notice your child sitting closer to the TV or turning the sound up louder than usual. Sometimes it may seem like your child isn’t paying attention to you.

Some children with middle ear fluid are at risk for delays in speaking or may have problems with learning or schoolwork. Children at risk may include those with:

Permanent hearing loss not caused by middle ear fluid
Speech and language delays or disorders
Developmental delay of social and communication skills disorders (for example, autism-spectrum disorders)
Syndromes that affect cognitive, speech and language delays (for example, Down syndrome)
Craniofacial disorders that affect cognitive, speech and language delays (for example, cleft palate)
Blindness or visual loss that can’t be corrected

If your child is at risk and has ongoing middle ear fluid, her hearing, speech and language should be checked out right away.

Some risk factors for ear infections and middle ear fluid can be avoided, some can’t. Studies have found that children who live with smokers, attend group child care, or use pacifiers have more ear infections. Because some children who have middle ear infections later get middle ear fluid, you may want to:

Keep your child away from tobacco smoke.
Keep your child away from children who are sick.
Throw away pacifiers or limit to daytime use (if your child is older than 1 year).

Since there are limited symptoms associated with middle ear fluid, there are two tests that can determine whether fluid exists: a pneumatic otoscope and tympanometry.

A pneumatic otoscope is the best test for middle ear fluid. With this tool, the pediatrician looks at the eardrum. Tympanometry is another test for middle ear fluid. Tympanometry shows how well the eardrum moves. An eardrum with fluid behind it doesn’t move as well as a normal eardrum. Your child must sit still for both tests; the tests are painless. Because these tests don’t check hearing level, a hearing test may be given, if needed. Hearing tests measure how well your child hears. Although hearing tests don’t test for middle ear fluid, they can measure if the fluid is affecting your child’s hearing level. The type of hearing test given depends on your child’s age and ability to listen.

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The information contrained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.