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.
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.
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).
Pediatric Ear, Nose and Throat Clinic
6400 Fannin St. Suite, 2700
Houston, Texas 77030
Phone: (713) 487-5000
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