Middle Ear Fluid

middle-ear-fluidFluid in the ear, also called serous otitis media (SOM) or otitis media with effusion (OME), is usually the result of an ear infection, but it can occur under any condition in which the auditory tube (eustachian tube) is impaired. The auditory tube allows fluid to drain from the ear into the back of the throat. If the auditory tube becomes clogged, fluid will become trapped in the middle ear space. In addition to ear infections, the common cold, sinus infections and allergies can often lead to fluid in the ear.

Who Gets Fluid in the Ear?
Anyone can get fluid in their ears, but it is much more likely to occur in children due to the anatomy of their auditory tube. According to the American Academy of Pediatrics, there are about 2.2 million cases in the U.S. each year, and about 90% of children will get it before they reach school age.

Symptoms of Fluid in the Ear
Fluid in the ears may or may not cause symptoms. If symptoms do occur, they can include mild ear pain that comes and goes,hearing loss, delayed development in speech and language skills in children, delayed gross motor skills and balance problems (vertigo) if the fluid goes undetected.

Diagnosing Fluid in the Ear
The best method for diagnosing fluid in the ear is examination of the ear using an otoscope or otomicroscopy. This procedure is very simple and involves pulling back the ear and inserting the tip of the otoscope into the ear. This allows the doctor to visualize the ear drum (tympanic membrane). Experienced physicians may actually see either a fluid level behind the ear drum, a bubble, or that the ear drum is immobile. Unfortunately, it is not always so clear and the only thing indicating fluid in the ear might be a slight retraction of the ear drum, or a slightly abnormal coloration.

otoscope1The presence of fluid in the ear can be confirmed by another test called tympanometry. This test has some similarities to an exam using an otoscope in that the ear will be pulled back and the tip of the instrument, also called the speculum, will be placed in the outer portion of the ear canal. Your child, (or you, if you’re the patient), should try to hold very still during this test and avoid speaking or swallowing if possible.

The instrument will measure the pressure inside of the ear then generate a tone. The tympanic membrane will reflect a certain amount of sound back into the tympanometer, which is charted on a graph called a tympanogram. If there is fluid in the ear, the tympanic membrane will stiffen and an abnormal amount of sound will be reflected.

Because fluid in the ear is often asymptomatic, especially in children, it often goes undiagnosed. If your child has symptoms of fluid in the ear it is best to take them to an ENT specialist or initially to the pediatrician. A specialist may have access to better diagnostic equipment, but even more importantly their experience is necessary to recognize subtle clues that might mean you have fluid in your ears. Early identification of hearing loss can help prevent developmental abnormalities.

How Fluid in the Ear Is Treated
Fluid in the ears can be present with or without an active infection. Antibiotics are of no use unless there is a current ear infection and will not be used.

Initially, the physician may start with an ant iinflammatory nasal spray like flonase or nasonex because of the effect on a potentially blocked eustachian tube. Healing the eustachian tube can be an important step in treating middle ear fluid because it forms the drainage of the middle ear.

If the middle ear fluid is not causing symptoms and there is no risk for delays in development (in children), the physician may choose to monitor the fluid in the ears and see if it will clear up without intervention. If it has been longer than a few months, or if your child’s development is affected, his or her doctor may choose to do a myringotomy. This is a surgical procedure in which a small incision is made in the ear drum and a tiny synthetic tube is placed inside called a ventilating tube. This will usually make it possible for the fluid to drain into the back of the throat. Even among children who require surgical intervention, full recovery is almost always achieved. Because of their anatomy, children are especially prone to have recurring fluid in the ear. ventilating tubes in adults are performed in the office under local anesthesia.