To diagnose acute otitis media requires three things: sudden onset of symptoms (ear pain or fever), fluid behind the eardrum, and an abnormal appearnce of the eardrum (redness, bulging, or opacity of the eardrum.
Chronic fluid behind eardrum, called otitis media with effusion (OME), is much more common than acute otitis media. About 90% of children will have one or more episodes of OME (fluid behind the eardrum) before reaching school age. The child doesn’t have symptoms of ear pain or of fever. The ear drum is usually not red. This fluid behind eardrum can be present for months at a time and usually resolves without treatment. OME can caused by eustachian tube dysfunction or by an acute otitis media which resolves but can cause chronic fluid behind the
Doctors diagnose fluid behind the eardrum by means of pneumatic otoscopy (gently puffing air at the eardrum to see how well it moves) or by tympanometry .
You can use the EarCheck home acoustic reflectometer to detect fluid behind your child’s eardrum.
We treat acute otitis media with antibiotic and pain medicine.
Otitis media with effusion, chronic fluid behind ear drum, doesn’t usually cause any symptoms. And antibiotics and antihistamine/decongestants don’t help get rid of the chronic fluid.
The reason that doctors are concerned about chronic fluid behind the ear drum is because it can cause chronic mild temporary hearing loss that can interfere with speech and language development.
Much less commonly, otitis media with effusion can cause damage to the eardrum or middle ear but this is uncommon and the doctor can watch for this by inspecting the eardrum.
If a child has had OME for 3 months or longer, the guideline (see reference) recommends a hearing test. If a hearing test shows significant hearing loss (meaning mild or more hearing loss), then evaluation for speech and language delay is indicated.
So if the hearing test shows moderate hearing loss (defined as a hearing loss of greater than or equal to 40 decibels), surgery to insert ventilation tubes into the ear drum is recommended because this level of hearing loss does interefere with speech and language development.
Mild hearing loss of 21 to 39 decibels can be treated with ventilation tube surgery or by helping the child maximize what he hears by having him sit up front in class and get close to the child (within 3 feet) when talking to him.
The above recommendations apply to children without special risk factors. There are no useful drugs to treat children with OME. If treatment is thought necessary, the treatment is surgery. And the initial surgery is placement of a ventilation tube in the affected eardrum.
Again, most children with chronic fluid behind the eardrum will resolve without tubes. And parents should discuss their options carefully with both their child’s primary physician and the ENT doctor if referred to one.
Some children are at increased risk of speech and language delay. These children include children with suspected or diagnosed speech and language delay, permanent hearing loss not due to OME, autism spectrum disorder and other pervasive developmental disorders, blindness, developmental delay, and cleft palate. These children require close monitoring and perhaps ventilation tube surgery at an early time.
For additional information about the risks and benefits of surgery see the AAP Clinical Practice Guideline: Otitis Media With Effusion at