No OTC Medication is Effective for Fluid Behind the Ear
There is no over-the-counter medication that helps with fluid behind the ear (otitis media with effusion), and you should not use antihistamines, decongestants, steroids, or antibiotics for this condition. 1, 2
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, including: 1, 2
- Antihistamines - Not effective 1, 2, 3
- Decongestants (like pseudoephedrine/Sudafed) - Not effective 1, 2, 3
- Combination antihistamine/decongestant products - Not effective 1, 2, 3
- Nasal steroids - Not effective 1, 2
- Oral antibiotics - Not effective 1, 2
A comprehensive Cochrane review of 16 studies with 1,880 participants found no statistical or clinical benefit from antihistamines or decongestants for middle ear fluid, and these medications actually caused 11% more side effects than placebo (meaning you'd need to treat only 9 people to cause one person harm). 3
What Actually Works: Watchful Waiting
The recommended approach is watchful waiting for 3 months from diagnosis, as fluid often resolves spontaneously without any medication: 1, 2
- 75-90% of cases clear within 3 months after a cold or ear infection 2
- This approach avoids unnecessary interventions with potential adverse events and costs for a condition that is usually self-limited 1
- The natural history strongly favors spontaneous resolution 1
What You Can Do at Home (Non-Medication Approaches)
While waiting for the fluid to resolve, these interventions may help: 1, 2
- Eliminate secondhand smoke exposure, especially in closed spaces like cars or the house 1, 2
- Stop pacifier use during daytime if the child is over 12 months old 1, 2
- These are the only home interventions with any supporting evidence 1
When to Seek Medical Intervention
Consider medical evaluation if fluid persists beyond 3 months, which may include: 1, 2
- Hearing testing 2
- Possible tympanostomy tube placement 2
- Follow-up every 3-6 months until fluid completely resolves 2
Earlier Intervention May Be Needed For At-Risk Children
Children with the following conditions may warrant evaluation and possible tube placement before the 3-month waiting period: 2
- Developmental delays 2
- Speech/language problems 2
- Learning difficulties 2
- Autism spectrum disorder 2
- Craniofacial disorders 2
- Visual impairment 2
Common Pitfall to Avoid
Do not waste money on OTC cold medications, herbal remedies, chiropractic care, special diets, or complementary/alternative therapies - none have ever been shown to provide any benefit for middle ear fluid. 1 The evidence is clear and consistent that medical treatment does not work well for this condition. 1