This is a clinical condition characterized by fluid accumulation in the middle ear cavity behind an intact eardrum, without signs of acute infection. Patients with this condition do not exhibit symptoms such as fever, redness, or severe ear pain. Fluid in the ear typically arises following an acute middle ear infection. The inflammation often causes an obstruction in the Eustachian tube. Over time, negative pressure develops in the middle ear. After a while, the middle ear mucosa undergoes a change that causes it to secrete mucus, leading to the fluid becoming persistent. In addition to middle ear infections, barotrauma, nasopharyngeal cancers, radiation therapy, and allergies can also cause fluid buildup in the ear. Especially in adults, when there is fluid buildup in one ear, the presence of a nasopharyngeal tumor must be ruled out.
Fluid buildup in the middle ear is one of the most common conditions in childhood. This is because the Eustachian tube is more parallel to the horizontal plane in young children. Children in preschool and daycare settings are at higher risk. Fluid buildup in the ear is more commonly observed in children from families where parents smoke. The presence of adenoids in children is a risk factor for fluid buildup in the ear, as the adenoids serve as a reservoir for microorganisms. When the fluid in the middle ear is examined, the microorganisms most frequently identified are the same as those found in acute otitis media: S. Pneumonia, H. Influenza, and M. Catarrhalis.
Fluid buildup in the middle ear is one of the most common childhood conditions. This is because the Eustachian tube runs more parallel to the horizontal plane in young children. Children in preschool and daycare settings are at higher risk. Fluid buildup in the ear is more common in children from families where parents smoke. The presence of adenoids in children is a risk factor for fluid buildup in the ear, as the adenoids serve as a reservoir for microorganisms. When the fluid in the middle ear is examined, the microorganisms most frequently found are S. pneumoniae, H. influenzae, and M. catarrhalis—just as in cases of acute otitis media.
HOW IS A DIAGNOSIS MADE FOR FLUID BUILD-UP IN THE MIDDLE EAR
In affected children, fever and severe ear pain are not typically observed. Children usually exhibit a state of restlessness. These children constantly bring their hands to their ears. Patients experience mild hearing loss. On examination, the eardrum appears dull and bulges outward. Over time, the eardrum begins to collapse. A tympanometry test reveals negative pressure in the middle ear, and acoustic reflexes cannot be detected. An audiometric test shows conductive hearing loss.
WHAT IS THE NATURAL COURSE OF FLUID BUILD-UP IN THE EAR?
Fluid in the ear usually resolves on its own within 3 months. However, in 10–20% of patients, the fluid may become permanent. In this case, over time, negative pressure causes the eardrum to begin to collapse. Over the years, the eardrum becomes adhered to the middle ear wall. The ossicles may begin to erode. In some patients, a condition known as cholesteatoma may develop.
HOW IS FLUID BUILD-UP IN THE EAR TREATED
Medication
Medication is the first-line treatment. Medications commonly used for this purpose include antibiotics, decongestants, antihistamines, steroids, and vaccines.
- Antibiotics: Antibiotics are the most commonly used medications in the treatment of fluid buildup in the middle ear. However, there is no consensus on the appropriate duration of antibiotic use. Many physicians prefer to prescribe antibiotics for a total of one month, divided into at least two 10-day courses. The most commonly used antibiotics for this purpose are amoxicillin-clavulanic acid, cephalosporins, co-trimoxazole, and macrolides.
- Decongestants: Their efficacy has not been scientifically proven. However, many physicians prefer to use topical decongestants for a short period (4–5 days) in conjunction with antibiotics. Some physicians may also use systemic oral decongestants for a longer duration.
- Steroids: While systemic steroids may help reduce fluid buildup in the short term, fluid tends to accumulate again over the long term. Given their side effects, the use of steroids is generally discouraged. However, topical steroids administered nasally may be used. However, their efficacy has not been proven.
- Antihistamines: The use of antihistamines is not an appropriate option unless there is an underlying allergy.
- Vaccines: Recent studies have shown that pneumococcal and Haemophilus influenzae vaccines have positive effects on the development and treatment of recurrent middle ear infections and otitis media with effusion.
Surgical Treatment
Surgical treatment is considered for fluid buildup that does not resolve with medication after more than three months. The method used in surgical treatment involves inserting a ventilation tube into the eardrum. The goal here is to break the vicious cycle by ensuring proper ventilation of the middle ear. Fluid buildup in the ear generally responds well to ventilation. However, in some cases, the ventilation tube may need to be replaced several times. In other cases, the condition may persist despite the ventilation tube. In such situations, more extensive surgery, such as a tympanomastoidectomy, may be required.
In some cases, the placement of a ventilation tube may be considered at an earlier stage. These situations include:
- Recurrent middle ear infections
- Collapse of the eardrum
- Hearing loss exceeding 35 dB
- Development of inner ear hearing loss
Ventilation tubes typically remain in place for about 6 to 12 months, depending on the type of tube. During this time, patients must keep their ears dry. Once the ear has healed, the tube usually falls out on its own, and no further procedure is required. The hole in the eardrum closes on its own within a short period of time. In very rare cases, the hole in the eardrum may not heal after the tube falls out. In such cases, surgical closure of the hole may be necessary.