Fluid in the Middle Ear

Boy listening to music through headphones

Serous otitis media, better known as middle ear fluid, is the most common condition causing hearing loss in children. Normally, the space behind the eardrum which contains the bones of hearing is filled with air. This allows the normal transmission of sound. This space can become filled with fluid during colds or upper respiratory infections. Once the cold clears, the fluid will generally drain out of the ear through a tube that connects the middle ear to the nose: the Eustachian tube. The Eustachian tube does not drain well in children. Fluid which has accumulated in the middle ear space often remains blocked.

Sound transmission is slowed by the fluid and hearing is diminished. Parents may notice that their child has the sound on the television turned up too loud; they might notice their child often asking, “What?” in response to a question. In many children, there may be no noticeable complaints. This is especially true when a child is less than 2 years old. Fluid can be present for months in children, only to be detected by a routine visit to the pediatrician’s office. Fluid often produces few symptoms, but can have significant consequences if not recognized.

Because children need hearing to learn speech, hearing loss from fluid in the middle ear can result in speech delay. Children begin to speak some words by 18 months. Children with fluid in both ears can show significant delay in their use of language. In addition, young children learn to pronounce words by hearing them spoken. When there is a hearing loss, even a mild one, the spoken words of parents and siblings are distorted to the child with fluid in the ears.

Little bot with little girl

Since the words sound distorted to the child, pronunciation of these words by the child will also be distorted. The extreme case of this distortion is the deaf child whose speech is very difficult to understand because the child does not hear at all. If a child has fluid for many months during the formative years, there may be noticeable mispronunciation which will require speech therapy. Identification of fluid in the middle ear is important, not only to prevent future speech problems, but to avoid permanent damage to the eardrum and the middle ear.

Most children will have at least one ear infection before the age of four. With treatment, the ear infections clear up promptly. A follow-up visit to the pediatrician or family doctor is essential, in order to be certain that the ear infection has cleared, and fluid no longer remains in the middle ear. Most primary care doctors recommend a revisit during the week after completing the antibiotic. Without the follow-up visit, fluid may still be present, even though the child has no complaints or symptoms. Therefore, it is essential that ear infections be rechecked after initial treatment.

Additional antibiotics may be prescribed, if fluid is still present at the follow-up visit. If fluid has not cleared over an eight to ten week period after an infection, referral to an ear, nose and throat specialist is advisable. A complete examination of the ear, nose and throat should be performed. Hearing tests should also be obtained to assess the degree of hearing loss from the fluid accumulation. Usually, the presence of fluid results in a “mild conductive hearing loss.” This could be as much as 30% hearing loss overall. In very young children (less than 2 years old), it may be very difficult to obtain accurate hearing tests, particularly for the individual ears. A general hearing level can usually be obtained, however. If the child is younger than 6 months old and does not seem to respond normally to environmental sounds, such as the doorbell, telephone ringing, or calling, a brain stem evoked response audiometry hearing test may be advisable to rule out a more severe hearing loss.