Q: My brother said his ear was feeling funny. The doctor said he had fluid in his ear and it would go away on its own. What is this from? A: Dysfunction of the eustachian tube may contribute to fluid build-up in the middle ear, called otitis media with effusion.

Q: My brother said his ear was feeling funny. The doctor said he had fluid in his ear and it would go away on its own. What is this from?


A: The auditory canal, or the "hole" in your ear, allows air to pass through the external ear to the eardrum, or tympanic membrane. Sound waves in the air make the TM vibrate. These vibrations are passed into the air-filled middle ear where tiny bones, such as the hammer, anvil and stirrup, are attached to the fluid-filled cochlea. The cochlea turns these mechanical vibrations into electrical impulses, which are sent to the brain via the auditory nerve. The brain interprets these electrical impulses, empowering our sense of hearing.


The eustachian tube connects the middle ear to the pharynx, which is the part of the throat in the back of the mouth. This allows air to flow in order to balance the middle-ear pressure with the auditory canal pressure. It also allows any fluid in the middle ear to drain. Dysfunction of the eustachian tube may contribute to fluid build-up in the middle ear, called otitis media with effusion, or glue ear because the thick fluid may "stick" to the TM.


Since OME often occurs after an acute ear infection, it is possible that inflammation from the infection causes eustachian tube dysfunction. It is also possible that eustachian tube dysfunction causes negative pressure, which "sucks" bacteria into the middle ear, causing the acute infection. Either way, infection and eustachian tube dysfunction are correlated and can lead to OME.


Although inflammation from an acute infection can cause fever and ear pain, OME is usually asymptomatic or has symptoms limited to a "fullness" or hearing loss in the affected ear. If the middle ear is filled with fluid instead of air, the vibration of the TM and the conduction of these vibrations by the ear bones is compromised.


OME is very common in kids, especially those under age 6, since their eustachian tubes and immune systems are not fully developed. In fact, tympanostomy tubes are used in about 7 percent of all U.S. children by age 3, which is more than 1 million per year. OME is much less common in adults, though data is limited.


OME is diagnosed by pneumatic otoscopy: while looking in the ear, the health care provider uses a small device to blow air against the TM, and if there is fluid in the middle ear, the TM will not move normally. Other tests may also be required, such as tympanometry to test compliance of the TM, reflectometry to measure how sounds reflects off the TM and hearing tests. If a mass causing the eustachian tube dysfunction is suspected, a CT scan or other imaging options may be indicated.


The vast majority of cases of OME resolve on their own, hence the initial treatment is "watchful waiting.” Since infection, possibly from bacteria, is associated with eustachian tube dysfunction, antibiotics may be prescribed. However, research has failed to show benefit from steroid or antihistamine medications. Periodic auto-inflation, which means blowing into a closed mouth or nose to "pop" the ears, may be beneficial for some patients.


After an appropriate "watchful waiting" period, which is typically three months or so, the OME severity is re-evaluated by seeing how much the patient's hearing is affected. For mild hearing loss, which is less than 20 decibels and similar to using earplugs, further “watchful waiting” may be indicated. For moderate hearing loss, which is 21 to 39 decibels, the patient's risk factors, such as the potential to have their language development compromised by the hearing impairment, must be carefully assessed to determine if surgery is indicated. For severe hearing loss, which is over 40 decibels, surgery will typically be recommended.


The surgical approach to OME is to place a small tube through the TM to allow air from the auditory canal to ventilate the middle ear, or the tympanostomy tubes. Depending on the age of the child, risk factors and symptoms, the tympanostomy tube selected may be a "short term" tube, which is intended to be in place for 8 to 18 months, or a "long term" tube, which is intended for over 18 months. These tubes are typically "pushed out" of the TM on their own, though they must be removed by the doctor in 5 percent to 10 percent of cases.


Other complications can occur, such as chronic perforation in the TM even after the tube comes out. Furthermore, 20 percent to 50 percent of kids treated with tympanostomy tubes have at least one recurrence of OME.


The risks and benefits of placing a tympanostomy tube must be weighed for each patient to determine the best treatment plan. Although initial evaluation of OME is usually performed by a child’s usual health care provider, early evaluation by an ear, nose and throat specialist may be indicated.


Jeff Hersh, Ph.D., M.D., F.A.A.P., F.A.C.P., F.A.A.E.P., can be reached at DrHersh@juno.com.