What is the treatment for fluid in the ear?

Treatment for Fluid in the Ear (Otitis Media with Effusion)

For fluid in the ear (otitis media with effusion), watchful waiting for 3 months is the recommended first-line approach, as 75-90% of cases resolve spontaneously without treatment. 1

Initial Management: Watchful Waiting

• Do not use medications - antibiotics, antihistamines, decongestants, intranasal or systemic steroids are strongly recommended against for treating OME, as they show no long-term benefit and carry risks of side effects 1, 2, 3
• Implement watchful waiting for 3 months from diagnosis or onset of effusion 1, 2
• Schedule follow-up visits every 3 to 6 months until the fluid resolves 1, 2

Environmental Modifications at Home

• Eliminate secondhand smoke exposure, particularly in enclosed spaces like cars and homes 1
• For children over 12 months who use pacifiers, discontinue daytime pacifier use to facilitate fluid resolution 1

When to Obtain Hearing Testing

• Obtain age-appropriate hearing assessment if:
  • OME persists for 3 months or longer 1, 2, 3
  • The child is at-risk (developmental delays, speech/language concerns, learning difficulties) regardless of duration 1, 2, 3
  • Bilateral OME with documented hearing loss requires counseling about potential speech and language development impacts 2, 3

Surgical Intervention Criteria

For children under 4 years old:

• Offer tympanostomy tubes when bilateral OME persists beyond 3 months AND causes hearing loss or hearing difficulties 1
• Consider tubes if chronic fluid contributes to balance problems, poor school performance, behavioral problems, ear discomfort, or reduced quality of life 1
• Do not perform adenoidectomy unless a distinct indication exists (nasal obstruction, chronic adenoiditis) 1, 2

For children 4 years and older:

• Offer tympanostomy tubes, adenoidectomy, or both when surgery is indicated 1, 2
• Adenoidectomy reduces future ear tube needs by approximately 50% 1

Tube selection:

• Use short-term tubes (8-18 months duration) unless there is a specific reason requiring longer placement, as they have lower risk of persistent perforation (2-3%) compared to long-term tubes 1

Important Caveats

Common pitfalls to avoid:

• Do not prescribe antibiotics - they may slightly reduce OME at 3 months but have uncertain effects on hearing and carry risks of resistance and side effects 1, 4
• Avoid chiropractic manipulation, special diets, herbal remedies, or alternative therapies - no benefits have been demonstrated 1
• Do not skip follow-up even if the child seems fine - young children often cannot express hearing difficulties, and prolonged fluid can cause eardrum damage 1, 2

Hearing optimization strategies while fluid is present:

• Position yourself close to the child when speaking and ensure face-to-face communication 1
• Speak clearly and repeat information as needed 1
• Recognize that hearing difficulties are typically mild and resolve when fluid clears, but can be frustrating for the child 1

Air travel considerations:

• When the ear is completely full of fluid (flat tympanogram), air travel is usually well-tolerated 1
• When fluid is partial or mixed with air, pain may occur during descent - keep the child awake during landing and encourage swallowing 1

Non-Pharmacological Option

• Autoinflation devices (such as Politzer devices) may be considered as a low-cost, low-risk intervention while awaiting natural resolution, though evidence quality is limited 5