What To Do If Fluid In Ear Won’t Drain?

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 block the eustachian tube and are mostly caused by chronic sinusitis.  

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. 

Understanding Why Fluid Can Accumulate in the Ears

There are many reasons why fluid can accumulate in the middle ear space.  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 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.  

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 <PE> 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 <PE> 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 <PE> 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.  

Dr. Liz White

Liz received her Doctor of Audiology (AuD) degree in 2005 from the University of Louisville School of Medicine. In the past 16 years, she has worked in the cochlear and osseointegrated implant industry, education, clinical and government. She is Board Certified by the American Board of Audiology. You can find Liz at Harbor City Hearing Solutions, FL.
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Dr. Liz White

Liz received her Doctor of Audiology (AuD) degree in 2005 from the University of Louisville School of Medicine. In the past 16 years, she has worked in the cochlear and osseointegrated implant industry, education, clinical and government. She is Board Certified by the American Board of Audiology. You can find Liz at Harbor City Hearing Solutions, FL.
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