Treatment for Fluid in the Ear of an Adult
For adults with otitis media with effusion (OME), watchful waiting for 3 months is the recommended initial approach, as fluid often resolves spontaneously without intervention. 1
Initial Management: Watchful Waiting
- Observation is the first-line strategy for adults with middle ear fluid that lacks signs of acute infection 1
- Fluid is most likely to resolve spontaneously if present for less than 3 months or has a known onset (such as after a cold) 1
- Follow-up should occur every 3 to 6 months until the effusion resolves 1
What NOT to Do
Medical therapies are explicitly not recommended for treating OME in adults, as they provide no proven benefit: 1
- Systemic steroids or intranasal steroids should NOT be used (strong recommendation against) 1
- Systemic antibiotics should NOT be used (strong recommendation against) 1
- Antihistamines and decongestants should NOT be used 1
- Alternative therapies including chiropractic, herbal remedies, and complementary medicine have no demonstrated benefit 1
When to Consider Intervention
If fluid persists beyond 3 months, further evaluation and potential intervention become appropriate: 1
- Obtain age-appropriate hearing testing if OME persists for 3 months or longer 2
- Consider tympanostomy tube placement if hearing loss is documented or quality of life is significantly impacted 1
- In adults, adenoidectomy is not typically indicated as it is primarily beneficial in children ≥4 years old 1
Critical Diagnostic Considerations
Rule out serious underlying pathology, as adult-onset middle ear effusion can signal concerning conditions: 3
- Nasopharyngeal examination is essential to exclude neoplastic disease, which is the most frequent cause of eustachian tube blockage in adults 3
- Unilateral effusion in adults warrants particularly careful evaluation for tumors 3
- Consider cerebrospinal fluid fistula if there is history of trauma or congenital anomalies 3
Symptomatic Management
While awaiting spontaneous resolution: 1
- Patients may experience mild discomfort, ear fullness, and mild hearing difficulties 1
- Avoid secondhand smoke exposure, which can impair resolution 1
- Air travel may cause discomfort when fluid is partially mixed with air; keeping the patient awake during descent and encouraging swallowing can help equalize pressure 1
Common Pitfall to Avoid
Do not confuse OME with acute otitis externa (AOE), which presents differently and requires topical antibiotic therapy: 1
- AOE presents with ear canal inflammation, pain, and often discharge 1
- OME is characterized by middle ear fluid without acute infection symptoms 1
- Interestingly, occult middle ear fluid can be present in up to 79% of acute otitis externa cases, though this resolves with treatment of the external ear infection 4