Fluid Collection in the Ear

  • Fluid Collection in the Ear

It is a clinical picture characterized by the accumulation of fluid in the middle ear cavity behind the intact eardrum without signs of acute infection. Symptoms such as fever, redness and severe ear pain are not seen in these patients. Fluid in the ear usually occurs following an acute otitis media. The effect of inflammation usually causes a blockage in the Eustachian tube. A negative pressure occurs in the middle ear over time. After a while, the middle ear mucosa undergoes a secretory change, causing the fluid in the ear to become permanent. Apart from middle ear infections, it can cause fluid collection in the ear in barotrauma, nasopharyngeal cancers, radiotherapy and allergy. The presence of a nasopharyngeal tumor must be ruled out, especially when there is unilateral accumulation of fluid in the ear in adults.

Fluid collection in the middle ear is one of the most common diseases of childhood. This is because the Eustachian tube is more parallel to the ground plane in young children. Children in kindergarten and nursery settings are more at risk. Fluid collection in the ear is more common in children of smoking families. The presence of adenoids in children is a risk factor for fluid collection in the ear because the adenoids act as a reservoir for microorganisms. When the fluid in the middle ear is examined, the microorganisms frequently produced are S. Pneumonia, H. Influenza and M. Catarrhalis, just as in acute middle ear infections.


Fever and severe ear pain are not usually observed in sick children. Children often have a state of restlessness. These children constantly bring their hands to their ears. Patients have a mild hearing loss. On examination, the eardrum is seen as opaque and bulging outward. Over time, the eardrum begins to collapse. In the tympanometry test, negative pressure is observed in the middle ear and acoustic reflexes cannot be obtained. Conductive hearing loss is observed in the hearing test.


The fluid in the ear usually disappears on its own within 3 months. However, fluid may be permanent in 10-20% of patients. In this case, with the effect of negative pressure over time, the eardrum begins to collapse. Over the years, the eardrum becomes attached to the middle ear wall. There is melting in the ear ossicles. Some patients may develop a disease called cholesteatoma.


Medication is the first-choice treatment method. The drugs that are frequently used for this purpose are antibiotics, decongestants, antihistamines, steroids and vaccines.

Antibiotics: Antibiotics are the most commonly used drug in the drug treatment of fluid collection in the middle ear. There is no consensus on how long the use of antibiotics should be. Many physicians prefer to use the antibiotic in the form of ten-day application at least twice for 1 month. The most commonly used antibiotics for this purpose are; amoxicillin-clavulanic acid, cephalosporins, co-trimaxazole and macrolides.
Decongestants: Their effectiveness has not been scientifically proven. However, many physicians use topical decongestants for short periods of time. (4-5 days) Prefers to use with antibiotics. Some physicians may use a longer-term oral systemic decongestant.
Steroids: Although systemic steroids help the fluid to disappear in the short term, fluid reoccurs in the long term. Considering the side effects, the use of steroids is inconvenient. However, topical steroids can be used by the nasal route. However, their effectiveness has not been proven.
Antihistamines:Unless there is an underlying allergy, the use of antihistamines is not the right option.
Vaccines:Studies conducted in recent years show that pneumococcal and H. influenza vaccines have positive contributions in the formation and treatment of the disease in recurrent middle ear infections and otitis media with effusion.
Surgical treatment
Surgical treatment comes to the fore in fluid collections that do not improve with drug treatment for more than three months. The method used in surgical treatment is to insert a ventilation tube into the eardrum. The aim here is to break the vicious circle by providing ventilation of the middle ear. Fluid collections in the ear usually respond well to the application of ventilation. However, in some cases, the ventilaston tube may have to be inserted several times. In some cases, the course of the disease may continue despite the ventilation tube. In this case, larger surgeries such as tympanomastoidectomy may be needed.
In some cases, ventilation tube application may come to the fore earlier.

These situations are;

  • Presence of recurrent otitis media
  • collapse of the eardrum
  • Hearing loss greater than 35 dB
  • Development of inner ear hearing loss

The inserted ventilation tubes stay around 6-12 months, depending on the type of tube. During this period, patients should protect their ears from water. When the ear heals, the tube is usually removed by itself and no action is required. The hole in the eardrum closes on its own in a short time.

Very rarely, the hole in the eardrum may not heal after the tube is removed. In this case, it may be necessary to close the hole surgically.

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