What is the treatment for fluid buildup behind the tympanic (eardrum) membrane?

From the Guidelines

The primary treatment for fluid buildup behind the eardrum (middle ear effusion) is watchful waiting for 3 months in most cases, as most cases resolve spontaneously. This approach is recommended because the condition often resolves on its own, and immediate medical intervention may not be necessary unless there are significant symptoms or the condition persists. According to the clinical practice guideline: otitis media with effusion executive summary (update) 1, fluid often goes away on its own, so watchful waiting for the first 3 months is often recommended.

Key Considerations

• The fluid is most likely to go away quickly if it has been there for less than 3 months or has a known start time, such as after a cold or ear infection 1.
• Medical treatment does not work well for fluid buildup behind the eardrum, and antibiotics, antihistamines, decongestants, steroids, or drugs to reduce acid reflux are not recommended unless there is a suspected bacterial infection or other specific conditions 1.
• For persistent cases or those with significant symptoms, myringotomy with tympanostomy tube placement may be considered to allow fluid drainage and pressure equalization 1.
• Addressing contributing factors like allergies, sinusitis, or adenoid hypertrophy may also be necessary for complete resolution 1.

Recommendations

• Keep the child away from secondhand smoke, especially in closed spaces, such as the car or in the house 1.
• If the child is over 12 months old and still uses a pacifier, stopping the pacifier in the daytime may help the fluid go away 1.
• Stand or sit close to the child when speaking and be sure to let them see your face. Speak very clearly, and if the child does not understand something, repeat it 1.
• Regular follow-up with a doctor every 3 to 6 months until the fluid goes away is recommended to monitor the condition and address any potential complications early 1.

From the Research

Treatment for Fluid Buildup Behind the Tympanic Membrane

The treatment for fluid buildup behind the tympanic membrane, also known as otitis media with effusion (OME), can vary depending on the severity and duration of the condition. The following are some treatment options:

• Watchful waiting: For children with mild symptoms and no evidence of hearing loss or language delay, a period of watchful waiting may be recommended 2.
• Antibiotics: Antibiotics may be prescribed for children with OME, especially if they have a history of recurrent acute otitis media or if they have a high risk of developing complications 3, 4.
• Steroids: Oral steroids may be used to treat OME, especially in children with persistent effusion and hearing loss 5.
• Grommet (ventilation tube) insertion: Grommet insertion is a surgical procedure that involves inserting a small tube into the eardrum to drain the fluid and improve hearing 6.
• Adenoidectomy: Adenoidectomy, which involves removing the adenoids, may be recommended for children with OME who have enlarged adenoids or recurrent infections 6.

Benefits and Risks of Treatment

The benefits and risks of each treatment option should be carefully considered. For example:

• Antibiotics: While antibiotics may be effective in treating OME, they can also have adverse effects such as diarrhea, vomiting, and skin rash 4.
• Grommet insertion: Grommet insertion can improve hearing and reduce the risk of complications, but it can also cause tympanosclerosis and other adverse effects 6.
• Watchful waiting: Watchful waiting may be a suitable option for children with mild symptoms, but it requires regular monitoring to ensure that the condition does not worsen 2.

Factors to Consider

When deciding on a treatment plan, the following factors should be considered:

• Duration and severity of symptoms: Children with persistent and severe symptoms may require more aggressive treatment 3, 5.
• Hearing loss and language delay: Children with hearing loss or language delay may require prompt treatment to prevent long-term complications 2, 6.
• Risk of complications: Children with a high risk of developing complications, such as recurrent infections or structural damage to the eardrum, may require more aggressive treatment 3, 4.