Fluid in the middle ear is a common ailment, especially among young children. Fluid accumulation occurs when the middle ear drainage pathway, the eustachian tube, is obstructed. Otitis media with effusion is the medical term for middle ear fluid. Head colds, allergies and other environmental factors can cause eustachian tube swelling and blockage. Fluid in the middle ear may clear spontaneously. Persistent otitis media with effusion may require medical intervention, especially if associated with significant hearing loss.
Watchful Waiting
The clinical practice guideline on otitis media with effusion issued by the American Academy of Family Physicians, the American Academy of Otolaryngology--Head and Neck Surgery, and the American Academy of Pediatrics recommends a 3-month period of watchful waiting for otherwise healthy children with this condition. The majority of children with otitis media with effusion show significant improvement or resolution of the condition within a 3-month timeframe.
Environmental Adjustments
During a watchful waiting period, environmental adjustments may be recommended to increase the likelihood of middle ear fluid resolution. The University of Maryland Medical Center notes that cigarette smoke is a known eustachian tube irritant. Exposure to secondhand smoke may provoke eustachian tube swelling and middle ear fluid accumulation. Appropriate steps to protect children and adults with middle ear effusion from cigarette smoke exposure may help promote spontaneous resolution.
Among infants that bottle feed, ensuring the baby does not feed while lying flat can help prevent eustachian tube irritation and middle ear infection. For a child attending group daycare, an alternative site of care without exposure to numerous children may be advisable, if possible. Minimizing exposure to other children decreases the risk for repeated colds, upper respiratory infections and middle ear infections. Actively minimizing exposure to allergic triggers among children and adults with allergies may promote resolution of middle ear effusion.
Medications
The otitis media with effusion clinical practice guideline issued by the American Academy of Family Physicians, the American Academy of Otolaryngology--Head and Neck Surgery, and the American Academy of Pediatrics does not recommend medications for the routine treatment of this condition. Citing numerous research studies that failed to show long-term benefit, the guideline specifically notes that antibiotics, decongestants, antihistamines and corticosteroids are not recommended for routine treatment of otitis media with effusion. However, treatment decisions are made on a case-by-case basis, taking into account the individual circumstances of each patient.
Ear Tubes
Children and adults with persistent otitis media with effusion may be candidates for ear tubes, also known as tympanostomy tubes. These small, button-like devices with a hole in the center are placed in the eardrum to allow fluid drainage from the middle ear. Informational material from the American Academy of Otolaryngology--Head and Neck Surgery notes that placement of ear tubes typically reverses the hearing loss associated with middle ear fluid.
References
- American Academy of Otolaryngology--Head and Neck Surgery: Ear Tubes
- American Academy of Otolaryngology--Head and Neck Surgery: Fact Sheet Chronic Otitis Media and Hearing Loss
- University of Maryland Medical Center: Otitis Media with Effusion
- American Academy of Family Practice: Clinical Practice Guideline, Otitis Media with Effusion
- American Academy of Otolaryngology--Head and Neck Surgery: Earaches
