How do I recognise fluid in the ear in my child?
Effusion is usually painless. What parents notice is hearing: the child asks "what?" often, turns the television up, does not react when called from another room or seems inattentive in a group.
In younger children, delayed or unclear speech, a feeling of pressure in the ear, restless sleep or repeated middle ear infections can be signs. Symptoms may last for weeks without any fever.
- Reduced hearing, frequent "what?", loud television
- Delayed or unclear speech development
- Pressure, popping or a blocked feeling in the ear
- Recurrent middle ear infections (otitis media)
When should my child see an ENT specialist?
An examination makes sense if reduced hearing lasts longer than about four to six weeks, if it keeps coming back, or if speech development may be affected. Several middle ear infections within a short period are another reason for a check.
In the practice I examine the eardrum with ear microscopy, measure eardrum movement with tympanometry and carry out an age-appropriate hearing test. Severe ear pain with high fever, swelling behind the ear or a sudden change in alertness needs immediate care — in an emergency call 144 (112 across the EU).
How is fluid in the ear treated?
Many effusions resolve on their own within a few weeks. During that time the ear and the hearing are monitored and the underlying cause is treated, for example blocked nasal breathing or an allergy; saline nasal rinses are commonly used. Decongestant nasal sprays, antihistamines and steroid nasal sprays have no proven lasting benefit for effusion itself, and antibiotics are generally not indicated without acute infection.
If fluid persists for months and hearing is measurably reduced, an eardrum incision (myringotomy) with ear tube insertion (tympanostomy tubes, called grommets in the UK and Ireland) is discussed, often together with removal of the adenoids (polyps). These procedures are performed in a hospital; whether they are appropriate depends on the findings.