OTC Medications for Fluid Behind the Ear
Do not use over-the-counter medications to reduce fluid behind the ear (otitis media with effusion), as they are ineffective and not recommended. 1
Why OTC Medications Don't Work
The American Academy of Otolaryngology-Head and Neck Surgery provides strong evidence-based recommendations against using any OTC medications for fluid behind the ear:
Medications That Are NOT Recommended
- Antihistamines: Ineffective for otitis media with effusion and should not be used 1
- Decongestants (oral or nasal): Do not help fluid resolve and are not recommended 1
- Steroids (oral or intranasal): Clinicians should recommend against using these for treating OME 1
- Antibiotics: Do not have long-term efficacy and are not recommended for routine management 1
- Acid reflux medications: No proven benefit 1
Research specifically demonstrates that intranasal decongestants like phenylephrine are ineffective and possibly detrimental for middle ear effusion 2, 3. Studies show that topical adrenergic decongestants do not improve abnormal middle ear pressures during common colds 3.
What Actually Works: Watchful Waiting
The recommended approach is watchful waiting for 3 months from diagnosis or onset of fluid. 1
Why This Approach Is Best
- Fluid often resolves spontaneously, with 75-90% of cases clearing within 3 months after a cold or ear infection 1
- This avoids unnecessary interventions with potential adverse effects and costs 1
- Medical treatments simply do not work well for this condition 1
What You Can Do at Home
While waiting for the fluid to resolve naturally:
- Avoid secondhand smoke exposure, especially in enclosed spaces like cars or homes 1
- Discontinue pacifier use during daytime if the child is over 12 months old 1
- Optimize communication: Speak clearly, face-to-face, in close proximity, and repeat when necessary since hearing may be temporarily reduced 1
When to Consider Medical Intervention
If fluid persists beyond 3 months, the child should be evaluated for:
- Hearing testing 1
- Possible tympanostomy tube placement (ear tubes), which is the only effective intervention for persistent fluid 1
At-Risk Children May Need Earlier Intervention
Children with developmental delays, speech/language problems, learning difficulties, autism spectrum disorder, craniofacial disorders, or visual impairment may warrant earlier evaluation and possible tube placement before the 3-month waiting period 1.
Common Pitfall to Avoid
Do not waste money on alternative therapies. No benefits have been shown for chiropractic care, special diets, herbal remedies, complementary medicine, or other "natural" therapies for otitis media with effusion 1.
Follow-Up Is Essential
Even if the child seems fine, follow-up every 3-6 months is necessary until the fluid completely resolves, as young children often don't express hearing problems well and long-standing fluid can cause ear damage requiring surgery 1.