Middle ear effusion is a common problem for young children (age 2 or less). Effusion is the buildup of fluid in the middle ear and is often seen after an ear infection has occurred. Fluid from the middle ear can remain trapped behind the eardrum making it hard for children to hear. This buildup of fluid can be difficult to identify because it causes no pain and has few side effects that a parent or caregiver would notice right away. Because effusions muffle a child’s ability to hear and process sounds, long term (chronic) middle ear effusions can cause speech or language delays.
What causes a middle ear infections with effusion?
Children are most susceptible to otitis media and are therefore susceptible to middle ear effusions because of their shorter, underdeveloped Eustachian tubes. The Eustachian tube connects the middle ear to the back of the throat where it drains away excess fluid and secretions made by the ear’s internal structures. But when irritants or illness strike, it can be easy for this small path to swell and become blocked—trapping fluid inside. Unable to drain, the ear’s secretions become stagnant and can become infected very quickly. This is known as an ear infection (acute otitis media).
Children who develop an ear infection will have pain—making it easy to know you need to seek medical attention. Antibiotics will be prescribed, or your doctor may let the infection resolve on its own and most children will make a quick recovery. But for a few, even though the pain is gone and they seem well, fluid may remain trapped behind the middle ear and fail to drain. There is no infection—just fluid. This is a middle ear effusion.
How is a middle ear infection with effusion identified?
In some cases, your healthcare provider may ask you to bring your child back for a follow up after an ear infection. He or she will be able to see the fluid behind the eardrum when they look inside with an otoscope. In these cases, your doctor will probably suggest monitoring the fluid to see if it will resolve on its own. Groups like the American Academy of Family Physicians recommends close monitoring of fluid that does not resolve (this is called “persistent otitis media with effusion” or OME). Additional treatments should be explored if speech, language or development are delayed.
As a parent or caregiver, you can also monitor your child’s development and report any changes or problems to your doctor. Watch children for these signs:
- Asking “What?” frequently when you speak to them
- Not responding to verbal cues like their name by their first birthday
- Slow speech development
- Slow learning
How are middle ear infections with effusion treated?
Chronic fluid behind the eardrum may need surgical intervention to drain fluid and ventilate the middle ear. This approach is reserved for children who are showing signs of hearing or speech delays and the decision to move forward with the procedure is unique to each case. A clinical practice guideline for the procedure has been published to provide recommendations on patient selection.
Also called tympanostomy tubes, ear tubes can be beneficial in eliminating or greatly reducing the amount of fluid in the middle ear and lowering a child’s risk for future ear infections. For placement, children are put to sleep under general anesthesia and a small hole is made in the eardrum. A thin plastic tube is inserted through the hole and otic antibiotics may be added to help eliminate or prevent infection. The procedure takes about 15 minutes and most children will have no pain. Draining the fluid often causes an immediate improvement in hearing and some children will say that sounds are louder than normal until they adjust. Talk to your doctor if you think your child may benefit from this procedure, or if you have more questions regarding middle ear effusion, OME, or other ear disorders.
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