Should I Have My Child Treated for Chronic Fluid Behind the Eardrum?

Introduction

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's advice.

Key points in making your decision

Recent medical research is changing the way many doctors treat ear infections. Consider the following when making your decision:

Children younger than 2 years of age who have had fluid behind the eardrum for longer than 3 months may need treatment right away to avoid hearing loss. This also includes children who are just learning to talk.
Children who have had fluid behind the eardrum for longer than 3 months need their hearing tested.
- If there is no hearing loss, you may choose to use home treatment for another 3 months. If the fluid isn't gone in another 3 months, you will need to consider other options.
- If hearing test results show your child has some hearing loss, your doctor may suggest options such as antibiotics or surgery to insert tubes in the eardrums.
If your child has had antibiotic medicines within the last few months, there may be concern about drug-resistant bacteria occurring. Your doctor may suggest surgery to insert tubes in the eardrums.

Medical Information

What is fluid behind the eardrum?

Fluid behind the eardrum, also called otitis media with effusion, is a buildup of fluid in the middle ear behind the eardrum without symptoms of infection. The condition, sometimes called glue ear, often follows an ear infection, although it can arise without one.

When swelling from a cold or allergy attack causes blockage of the eustachian tubes, air can't reach the middle ear. The vacuum and suction created by the blockage pulls fluid into the middle ear and prevents this and other fluids from draining out of the middle ear. The fluid that builds up is called effusion.

When is the buildup of fluid in the middle ear considered chronic?

Fluid in the middle ear behind the eardrum following an ear infection is normal. In most cases, the fluid will clear up within 3 months without treatment. If the fluid stays for longer than 3 months, it's considered chronic. However, if after 3 months the child doesn't have hearing loss, you may decide to treat him or her at home for another 3 months.

How is chronic otitis media with effusion treated?

Watchful waiting may be all that is needed. This means that you keep an eye on symptoms and if they improve, no treatment is necessary. Fluid behind the eardrum after an infection is normal. The fluid often clears up within 3 months without treatment. If the fluid persists and there is hearing loss, the treatment options are antibiotics and surgery. Surgical procedures that treat this condition include placing tubes into the eardrum to drain the fluid or removing the adenoids and, possibly, the tonsils.

How can I tell if my child has otitis media with effusion?

A child who has otitis media with effusion might experience popping, ringing, or a feeling of fullness or pressure in the ear. He or she may also have a loss of hearing, which may make him or her seem dreamy or grumpy. However, some children have no symptoms with this condition.

What are the risks of chronic fluid behind the eardrum?

Ongoing fluid behind the eardrum can cause temporary hearing loss and, rarely, permanent hearing loss. This is of greater concern in children younger than 2 years, as normal hearing is important when children are learning to talk.

For more information, see the topic Ear Infections.

Your Information

Your choices are:

Use home treatment, and see whether the fluid goes away on its own.
Talk with a health professional about treatment options, including antibiotics and ear tubes.

The decision about whether to have your child treated for fluid behind the eardrum takes into account your personal feelings and the medical facts.

**Deciding about treating fluid behind the eardrum**
Reasons to have your child treated for fluid behind the eardrum	Reasons not to have your child treated for fluid behind the eardrum
Chronic fluid behind the eardrum can damage the eardrum, possibly causing hearing loss. Hearing loss in a young child who is learning to talk may cause problems in developing speech and language skills. Treatment with antibiotics or ear tubes can improve hearing and will reduce the risk of temporary or permanent hearing loss. Fluid behind the eardrum raises the chance for repeat infection. Tubes can relieve pressure and pain in the ears. Are there other reasons you might want to have your child treated for fluid behind the eardrum?	Fluid will often go away with time and home treatment. Minor complications including thickening of the eardrum or drainage from the ear (otorrhea) occur in up to half of children who have tubes inserted. Many children who have tubes inserted have to go through the procedure more than once. Tubes are inserted under general anesthesia, which carries risks. Antibiotics may only temporarily clear up fluid behind the eardrum, and they can produce side effects including nausea, diarrhea, other infections, rashes, hives, or itching. Are there other reasons you might not want to have your child treated for fluid behind the eardrum?

These personal stories may help you make your decision.

Wise Health Decision

Use this worksheet to help you make your decision. After finishing it, you should have a better idea of how you feel about having your child treated for fluid behind the eardrum. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I am comfortable with delaying treatment to see if my child's condition will go away on its own without use of antibiotics or surgery.	Yes	No	Unsure
My child has had fluid behind his or her eardrum for more than 3 months.	Yes	No	Unsure
My child is learning to talk, so hearing is important.	Yes	No	Unsure
My child's hearing test showed some hearing loss.	Yes	No	NA
My child has difficulty taking medications.	Yes	No	Unsure
My child has taken lots of antibiotics over the last few months, and I am concerned about developing drug-resistant bacteria.	Yes	No	Unsure
My health insurance covers the cost of antibiotics or ear tubes.	Yes	No	Unsure
I am concerned about general anesthesia.	Yes	No	Unsure

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have your child treated for fluid behind the eardrum.

Check the box below that represents your overall impression about your decision.

Leaning toward having my child treated for fluid behind the eardrum

Leaning toward NOT having my child treated for fluid behind the eardrum

Return to the topic Ear Infections.

Credits

Author	Debby Golonka, MPH
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Denele Ivins
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer	Charles M. Myer, III, MD - Otolaryngology
Last Updated	February 28, 2007

Author:	Debby Golonka, MPH	Last Updated: February 28, 2007
Medical Review:	Michael J. Sexton, MD - Pediatrics Charles M. Myer, III, MD - Otolaryngology
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