Fluid in the ear is a common problem in children, but it can be seen in adults too. The fluid is behind the eardrum (tympanic membrane) and is meant to drain down through the eustachian tube naturally. However, in some cases, due to anatomy of the middle ear, the fluid cannot drain naturally. There are a few ways to diagnose fluid behind the eardrum such as the use of a pneumatic otoscope or performing some audiological tests. In some cases, the fluid can drain on its own. Sometimes, medication is needed; but in some cases, if the fluid is not draining at all, a surgery is recommended placing tympanostomy tubes. These choices are decided by the doctor and the patient or family.
Common Causes of Fluid in Ears
Fluid can be caused by a variety of factors. The most common is an ear infection, this is called otitis media with effusion. This happens mostly to children due to their middle ear anatomy and the size of their eustachian tube (this is the tube that connects the middle ear space to the throat). About 90% of children will get fluid in their middle ear space before they reach 5 or 6 years old.
Another reason for fluid behind the ear are allergies or enlarged sinus tissue (tonsils, adenoids, nasal polyps). These disorders can cause a blockage to the eustachian tube and are mostly caused by chronic sinusitis or mucus.
A simple cold may cause ear fluid. Most people have had fluid at some point in their lives, usually before they enter school. Congestion may also cause fluid behind the eardrum. Congestion causes negative pressure in the middle ear space thereby impeding the fluid from naturally exiting through the eustachian tube.
Another cause of middle ear fluid is cigarette smoke. Smoke causes irritation to the eustachian tube which can lead to swelling, obstruction and pain.
Changes in air pressure (flying in an airplane/scuba diving) may also cause fluid in the middle ear space.
Radiation to the ear/head/neck/brain can also cause fluid in the middle ear space due to inflammation or changes to the density of the middle ear bones.
Even pregnancy can cause fluid in the middle ear space. The heart is working harder to pump blood, oxygen and other fluids around the body and sometimes, extra fluid ends up behind the eardrum (tympanic membrane).
Fluid in the middle ear space causes a temporary conductive hearing loss prior to treatment.
Having fluid in the ears may cause discomfort or dizziness which is why it is important to determine the cause and find relief.
Checking for Fluid in Ears
If you think you might have fluid in your ears, it’s important to get a proper evaluation. Sometimes, fluid in the middle ear can be hard to detect on your own, especially if there’s no pain or infection. An audiologist or ear specialist can check for fluid using a simple tool called a tympanometer. The test is called tympanometry, which gently tests how your eardrum moves. If fluid is present, the eardrum may not move as it should. A hearing test may also be recommended to see if the fluid is affecting how well you hear.
Trying to diagnose ear problems at home isn’t always accurate. That’s why it’s best to visit an audiologist if you have symptoms like muffled hearing, ear pressure, or balance issues. Early testing can help prevent long-term problems and lessens the risk of getting complications. If you’re unsure, schedule a hearing check—it’s quick, painless, and a smart step for your ear health.
Doctors can explore treatments and strategies and give you proper information on how you can find relief from your condition. Managing symptoms early has its benefits, so make sure to see your health care provider as soon as possible.
Understanding Why Fluid Can Accumulate in the Ears
There are many reasons why fluid can accumulate in the middle ear space or ear drum.
Here is a review of some of the reasons why fluid can pool in the middle ear.
One of the most common reasons is the anatomy and the size of the head. In children, their eustachian tube can be in a more horizontal plane than a vertical plane. In these cases, the middle ear fluid is not able to drain because of gravity and the horizontal plane. Children also tend to have a smaller opening of the eustachian tube than adults, which can affect the movement of middle ear fluid.
Another reason why fluid can accumulate is due to inflammation of the middle ear space. If the eustachian tube is also inflamed or swollen, the middle ear fluid will not be able to properly drain down the tube therefore causing an accumulation of fluid behind the eardrum.
Colds and viruses can cause fluid accumulation in the ear. Congestion can cause negative pressure which affects the eardrum (tympanic membrane) which in turn affects the eustachian tube from serving its purpose of allowing the fluid to drain from the middle ear space.
Allergies, ear/nose/throat issues such as nasal polyps, enlarged tonsils, and enlarged adenoids can cause inflammation of the head and neck therefore blocking the eustachian tube and preventing fluid from draining from the middle ear space.
Flying in an airplane or scuba diving can cause pressure changes in the middle ear which in turn can thwart fluid from passively draining down the eustachian tube.
Treating Fluid In Ears
There are a few different approaches to treatment. In some cases, middle ear fluid can resolve on its own with just a wait and see approach. Typically, the fluid will clear up in one to two weeks. If the fluid does not clear on its own after the wait and see approach, more aggressive approaches are taken.
Sometimes, prescription antibiotics are recommended to treat the middle ear infection but often, the bacteria become resistant to the antibiotics.
There is often pain associated with fluid in the middle ear so a physician may recommend over the counter pain relievers or some kind of anesthetic drop in the ear canal if the eardrum (tympanic membrane) is not perforated.
Antihistamines may help if fluid in the ear is caused by allergies, sinus congestion, or mucus from a cold. These medications work by reducing inflammation and drying up excess mucus in the nasal passages and Eustachian tubes—the small tubes that help drain fluid from the middle ear. When these tubes become blocked due to allergies or a cold, fluid can build up behind the eardrum and affect your hearing.
While antihistamines can provide relief in some cases, they don’t work for everyone. They’re generally more effective if your ear fluid is related to an allergic reaction rather than an infection. It’s also important not to overuse them, especially in children, without medical guidance.
If your symptoms don’t improve or you’re unsure what’s causing the fluid buildup, it’s best to see an audiologist. They can help determine the root cause and recommend the most appropriate treatment—whether it’s medication, monitoring, or other care. Don’t wait too long—early evaluation can prevent complications and protect your hearing.
When the fluid will not clear after the previous approaches, tympanostomy tubes are recommended or if a person has many ear infections within a certain amount of time. This is a surgical procedure performed by an ear, nose and throat physician. A small hole (myringotomy) is made in the affected eardrum and then the fluid is suctioned from the middle ear space. A small tube called a tympanostomy tube (or pressure equalization tube) is placed in the whole to allow ventilation and prevent further fluid buildup. Some tubes are designed to stay in place for a few months and they fall out on their own when the eardrum closes around it. Other tubes are meant to stay semi-permanently and may need to be surgically removed.
When To See A Doctor
An adult with middle ear fluid or suspected middle ear fluid should visit a doctor if the symptoms last for more than a day. Typical symptoms for adults are ear pain (otalgia, ear drainage, or muffled hearing).
A child with middle ear fluid or suspected middle ear fluid should visit a doctor if the symptoms last more than a day and are present in a child younger than six months of age. Children may be unable to articulate their pain level. Some signs or symptoms a child may show are fussiness, ear pain (especially when lying down), pulling on ear, insomnia, crying, no response to sounds, loss of balance, fever of 100 degrees F or more, ear drainage, loss of appetite and/or headache.
It is recommended to see an ear, nose, and throat physician as the ear is their speciality and this type of physician has the correct instrumentation to diagnose. Typically, an ENT physician will use a pneumatic otoscope which allows a puff of air to move the eardrum (tympanic membrane). If the eardrum is full of fluid, the eardrum will have little movement or no movement. An ENT office will typically have an audiologist on staff who can perform certain audiologic tests to confirm the presence or absence of fluid.
Ear Tubes for Ear Infection
When the fluid will not clear, tympanostomy tubes are recommended or if a person has many ear infections within a certain amount of time. This is a surgical procedure performed by an ear, nose and throat physician. The surgery is performed in an outpatient surgical suite. The procedure usually takes a few minutes to complete. A small hole (myringotomy) is made in the affected eardrum and then the fluid is suctioned from the middle ear space. A small tube called a tympanostomy tube (or pressure equalization tube) is placed in the whole to allow ventilation and prevent further fluid buildup. Some tubes are designed to stay in place for a few months and they fall out on their own when the eardrum closes around it. Other tubes are meant to stay semi-permanently and may need to be surgically removed.
Fluid In Ear Won’t Drain: Is Surgery Needed?
When the fluid will not clear, tympanostomy tubes are recommended or if a person has many ear infections within a certain amount of time. This is a surgical procedure performed by an ear, nose and throat physician. The surgery is performed in an outpatient surgical suite. The procedure usually takes a few minutes to complete. A small hole (myringotomy) is made in the affected eardrum and then the fluid is suctioned from the middle ear space. A small tube called a tympanostomy tube (or pressure equalization tube or ventilation tubes) is placed in the whole to allow ventilation and prevent further fluid buildup. Some tubes are designed to stay in place for a few months and they fall out on their own when the eardrum closes around it. Other tubes are meant to stay semi-permanently and may need to be surgically removed.
These tubes decrease the frequency of ear infections by allowing air into the middle ear space and helping fluid to drain down the eustachian tube into the throat. As mentioned above, the procedure is performed in an outpatient surgical setting. The surgery is very common and safe and only takes a few minutes typically.
Sometimes, the surgery is performed in the physician’s office for adult patients. The ear canal and eardrum (tympanic membrane) are numbed for the procedure.
Frequently Asked Questions
Will fluid in the ear go away on its own?
In many cases, yes—fluid in the ear can go away on its own, especially if it’s caused by a minor cold or allergy. However, fluid that stays trapped in the middle ear for several weeks or more may need medical attention. If the fluid doesn’t clear up or if it causes discomfort, balance problems, or hearing changes, it’s a good idea to see an audiologist. They can check for any underlying issues and guide you on the best treatment options.
Can fluid in the ear affect hearing?
Yes, fluid in the ear can definitely affect your hearing. When fluid builds up behind the eardrum, it can block sound from passing through as clearly, causing muffled or reduced hearing. This is especially common in children, but it can happen at any age. If you notice changes in how you hear or if sounds seem dull, it’s important to see an audiologist. They can perform a hearing test and help determine whether the fluid is affecting your hearing.
How long does it take for fluid in ear to clear up?
The time it takes for fluid to clear from the ear can vary. In many cases, it may go away within a few days to a few weeks. But if the fluid stays longer than 4–6 weeks, it may be a sign of a more persistent problem. Chronic fluid buildup can lead to ongoing hearing issues or even infections. If your symptoms continue, don’t wait—visit an audiologist to have your ears examined and get expert care.
Bottomline
While fluid in the ear often clears up on its own, it’s important not to ignore ongoing symptoms. If you’re experiencing muffled hearing, a feeling of fullness in the ear, ear pressure, discomfort, balance or hearing problems, don’t wait for it to get worse.
An audiologist can evaluate your ears, check your hearing, and recommend the right treatment. Early care can help you avoid complications and protect your long-term ear health. If you have concerns about fluid in your ear or changes in your hearing, schedule an appointment with an audiologist today to get an accurate diagnosis and shed light on what’s causing your hearing concerns.
