When You Have Fluid in the Ear

Fluid in the ear can be due to inflammation or congestion that blocks the eustachian tube, a small drainage passageway in your ear. This can happen when you have an ear infection, allergies, or the common cold. The blockage causes trapped fluid in the middle ear to fill the space behind the eardrum, leading to symptoms like muffled hearing and pressure or pain in the ear.

Having fluid in your ear is called serous otitis media (SOM) or otitis media with effusion (OME).

This article goes over what causes fluid buildup in the ear, how fluid in the ear is diagnosed and treated, and how you can prevent fluid from collecting in your ears.

Symptoms of Fluid in the Ear

Symptoms of fluid in the ear can be mild or severe.

Possible symptoms include:

• Ears that feel "plugged up" or fullness in the ears
• Increasing ear pain when changing altitude; not being able to "pop" the ears
• Ringing in the ears (tinnitus)
• Hearing loss or muffled hearing
• Behavior problems and poor school performance
• Rarely, you can have balance problems that cause you to feel dizzy or experience vertigo (the feeling like everything around you is spinning)

If you've had fluid in your ear before, you might be able to tell that it's built back up again and know that you'll need treatment.

Fluid in the Ears of Babies and Toddlers

Small children may not have symptoms of fluid in the ear at all. If they do, they may not be able to tell an adult what's wrong.

If the child's ear pain is not severe, caretakers may not even realize there's a problem.

Fluid in the ear may not be suspected until a small child exhibits issues like balance problems, speech delays, or difficulty hearing/passing a hearing exam.

Causes of Fluid in the Ear

Fluid in the ears is caused by some form of auditory tube dysfunction.

Common causes include:

• Allergies
• Congestion from a cold virus, infection, or even pregnancy
• Enlarged sinus tissue, nasal polyps, tonsils, adenoids, or other growths that block the auditory tube (usually caused by chronic sinusitis)
• Chemical irritants like cigarette smoke
• Damage from radiation to treat head and neck cancer
• Barotrauma to the ears (rapid changes in air pressure around you, such as when you're flying in an airplane or scuba diving)
• Oral differences that can occur with Down syndrome or cleft palate
• Rarely, surgeries that cut across the auditory tube

Anyone can get fluid in their ears. However, it's much more likely to occur in children because their auditory tubes are small.

Children's tubes also run in a more horizontal direction than adults, which can encourage fluid to pool in the ear.

Diagnosing Fluid in the Ears

Fluid in the ear often goes undiagnosed because it may not cause any symptoms. If your child has symptoms but you're not sure what could be causing the fluid build-up in their ears, they should see their pediatrician or an ear, nose, and throat specialist (otolaryngologist).

A specialist may have better diagnostic equipment to figure out what's causing the fluid buildup in a child's ear. More importantly, a specialist's experience helps them recognize subtle clues that could mean there's fluid trapped in the ear.

Otoscope Exam

The best method for diagnosing fluid in the ears—particularly related to OME—is an ear exam with a handheld tool called an otoscope or otomicroscope. Otoscopes are more common because they're less expensive, but otomicroscopes allow for a more accurate diagnosis.

Checking the ear with an otoscope is very simple. The healthcare provider pulls back the ear and gently inserts the tip of the otoscope. The scope brings the eardrum into view.

Experienced providers can see either a bubble or fluid level behind the eardrum. They may also see that the eardrum does not move as it should.

Sometimes, the only indication that there's fluid in the ear is a slight retraction of the eardrum or abnormal color to it. That's why it takes a skilled provider to make a diagnosis.

Tympanometry Exam

Fluid in the ear can be confirmed by another test called tympanometry. This test is similar to an otoscope exam, but the provider uses a tool called a tympanometer.

For the test, the tympanometer is placed in the outer ear canal. It's important to hold very still during this test. If possible, you should not talk or swallow during the exam.

The instrument measures the pressure inside the ear.

How Is Fluid in the Ear Treated?

You may not need treatment for fluid in the ear that's caused by otitis media with effusion. The fluid usually drains on its own within a few weeks. However, if it does not, the treatment will depend on several factors.

• If the fluid is present for six weeks, treatment may include a hearing test, a round of antibiotics (if you have an active infection), or further observation.
• If the fluid is present after 12 weeks, you will need a hearing test. If there is significant hearing loss, a provider may consider antibiotics or placing tubes in your ears.
• If the fluid is still present after four to six months, you may need to have tubes placed in your ears surgically even if you don't have much hearing loss.
• If your adenoids are so large that they block your auditory tubes, they may need to be removed.

Antihistamines may help keep allergy symptoms and chronic sinusitis from clogging your ears, but they will not necessarily rid your ears of fluid that's already there.

Children who are at a higher risk of complications from fluid in the ears, including those with developmental delays, may need earlier treatment.

If your child does not need treatment for fluid in the ears, your provider might tell you to manage their symptoms and wait for the fluid to clear up on its own. When fluid in the ear is caused by otitis media with effusion, the condition usually goes away whether or not a child has surgery.

Can You Prevent Fluid in the Ear?

These steps may help to prevent fluid from collecting in the ear:

• Quit smoking and try not to be around cigarette smoke.
• Stay allergy-free. Avoid substances that trigger your allergies (allergens).
• Limit exposure. If your child is in daycare, consider switching to a smaller daycare (fewer kids means less exposure to germs).
• Keep things clean. Wash your hands and your child’s toys frequently.
• Avoid overusing antibiotics. Don't take antibiotics if you don't need to and don't take them for longer than is necessary. For example, If you have a viral infection, antibiotics won't help.
• Consider breastfeeding if possible, even for just a few weeks. Infants who are breastfed get sick less often and are less likely to get ear infections even years later.
• Stay up to date on vaccines. The pneumococcal vaccine (Prevnar) helps prevent the most common type of ear infection. Getting a yearly flu shot may help as well.

Summary

Fluid in the ear is a common condition that does not always need to be treated. Otitis media with effusion is the medical term for fluid buildup behind the eardrum. It's a common reason for there to be fluid in the ears, especially in kids.

Having fluid in your ear can be caused by inflammation, mucous, a growth, or a structural problem in the ear that blocks the drainage of fluid from your auditory tube.

You may or may not have symptoms if you have fluid in your ears. You might feel pain or notice changes in how things sound if the fluid has built up.

Many times, fluid in the ear gradually goes away on its own. If you have an infection, you may need antibiotics. If the fluid buildup in your does not get better or gets worse, you might need surgery to help drain it.

Simple strategies may help prevent fluid buildup, like avoiding irritants and allergens; washing your hands, keeping your child's toys and play areas clean, and staying up-to-date on vaccines.