Middle Ear Fluid in Young Children
Posted on February 13 2012, 12:55:41 PM | Posted by jtcweb
This guide is about middle ear fluid in children birth through five years who have no other health problems. After reading this guide, you should know more about:
- Causes of middle ear fluid
- Tests for middle ear fluid and hearing
- Treatments for middle ear fluid and for hearing loss caused by middle ear fluid
- How to work with your child’s health care provider to find the best treatment for your child’s middle ear fluid
Another name for middle ear fluid is otitis media with effusion. Some people also call it “glue ear.” Otitis media means middle ear inflammation and effusion means fluid.
The information in this post is based on a pamphlet, Middle Ear Fluid in Young Children, Otitis Media with Effusion - A Parent Guide, distributed by the U.S. Department of Health and Human Services, Agency for Health Care Policy and Research. It has been updated with guidelines from the American Academy of Pediatrics for treatment of Otitis Media with Effusion (May 2004).
How Does My Child Hear
The ear has three parts – the outer ear, the middle ear and the inner ear. The outer ear includes the part outside the head and the ear canal. The eardrum is a small circle of tissue, about the size of a fingertip, at the end of the canal. The middle ear is the space, usually filled with air, behind the eardrum. When a child has middle ear fluid, this is where it is found. A small tube – the eustachian tube – connects the middle ear to the back of the nose. The ossicles are three tiny bones (the malleus, incus and stapes) which connect the eardrum through the middle ear to the inner ear. The inner ear is further inside the head and is important for hearing and balance.
In a healthy ear, sound waves travel through the ear canal and make the eardrum move back and forth. This makes the three bones in the middle ear move. The movement of these bones sends sound waves across the middle ear to the inner ear. The inner ear sends the sound messages to the brain. But if the middle ear has fluid in it, then the eardrum and the bones cannot move well. This could cause your child to have trouble hearing.
What is middle ear fluid?
If your child has middle ear fluid, it means that a watery or mucus-like fluid has collected behind the eardrum. Many children get middle ear fluid during their early years. But, middle ear fluid is not the same as an ear infection.
- An Ear Infection often happens in only one ear at a time. With a middle ear infection your child may have fever and sharp ear pain. When your health care provider looks into your child’s ear, he or she might see a bulging red eardrum and some fluid in the middle ear.
- Middle Ear Fluid is usually found in both ears at once. Most children do not have fever or pain with middle ear fluid. A special test is needed to look for this fluid.
What causes middle ear fluid?
Here are some things that may cause middle ear fluid to occur in your child:
- Past ear infection. It is common for children to have middle ear infections. And, some children with middle ear infections later have middle ear fluid.
- Blockage of the eustachian tube (See cross-section of the ear.)
- Cold, flu or other inflammation
There is no one cause for middle ear fluid. Often, your child’s health care provider will not know what caused the middle ear fluid.
Why should I worry about middle ear fluid?
Most health care providers and parents worry that a child who has middle ear fluid in one or both ears may have trouble hearing. Experts do not know how much middle ear fluid affects hearing. There is some evidence that hearing loss from middle ear fluid may cause delays in learning to talk, and sometimes later on, problems with school work. However, experts do not know for sure what the long-term effects of middle ear fluid are. How do I know if my child is affected by middle ear fluid? Sometimes a child with middle ear fluid does not hear well. The most common complaint of parents whose child has middle ear fluid is that the child turns the sound up too loud or sits too close to the television set. Or, sometimes, the child does not seem to be paying attention. Speak to your child’s health care provider if you are concerned about your child’s hearing. Your child’s health care provider may use the following tests to check for middle ear fluid.
Tympanogram
(shaded area shows normal eardrum mobility)
A Pneumatic Otoscope may be used to check for middle ear fluid. With this tool, the health care provider looks at the eardrum. The fluid in the middle ear may be seen behind the eardrum. Even when the fluid cannot be seen, the health care provider can test for fluid with this tool by blowing a puff of air onto the eardrum to see how well the eardrum moves. The child must be still for this test to work. The child will feel the otoscope in the ear, but the test does not hurt. This test does NOT measure the child’s hearing level.
Tympanometry is another test for middle ear fluid. Tympanometry helps the health care provider find out how well the eardrum moves. For tympanometry, a soft plug, about the size of a person’s little finger, is placed snugly into the ear canal. The earplug is connected to the machine called a tympanometer. The child hears a low noise for a short time while the machine records how the eardrum reacts. An eardrum with fluid behind it does not move as well as a normal eardrum. Like the first test using the pneumatic otoscope, the child must sit still and will feel the plug in the ear. Tympanometry does NOT measure hearing level.
Hearing Testing may be done to see how well your child hears. Hearing testing does NOT test for middle ear fluid. In this case, it measures if the fluid is affecting your child’s hearing level. The type of hearing test used depends on your child’s age and listening ability. The child being tested above is playing a listening game. When she hears the sound, she puts a toy in the box.
When should Middle Ear Fluid be treated?
The treatment that your child gets for middle ear fluid depends on:
- How long your child has had middle ear fluid.
- If the fluid is causing hearing problems for your child.
- If your child has speech, language or developmental delays.
Remember to discuss all treatments with your child’s health care provider. Be sure to ask about the advantages and disadvantages of each treatment.
Here are some examples of how your child might best be treated for middle ear fluid.
If your child has had middle ear fluid for up to three months, then your child’s health care provider may recommend one of these treatments:
- Observation OR antibiotic therapy. You and your health care provider may choose observation because antibiotic therapy can cause some unwanted effects.
- Taking steps to prevent middle ear fluid (especially keeping your child away from cigarette smoke).
If your child has had middle ear fluid for three months or more, then your child’s health care provider may recommend the following treatments:
- A hearing test is recommended if your child has had middle ear fluid for three months or more. If this shows that your child has a hearing loss, your child’s health care provider may recommend surgery to put tubes in the eardrums.
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