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This one is about: Middle Ear Fluid in Young Children, Part I

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Middle Ear Fluid in Young Children, Part I

This article was put out by the U.S. Department of Health and Human Services on Middle Ear Fluid in Young Children. It's very comprehensive. Of course, it deals with otherwise healthy children ages 1 - 3 yrs., and does not address the special considerations of cleft affected children, but it's interesting reading nonetheless.

Middle Ear Fluid in Young Children
by U.S. Department of Health and Human Services

Summary: This article is about middle ear fluid in children ages 1 through 3 who have no other health problems. The article addresses the causes of middle ear fluid, the tests for fluid, the types of treatment and how to work with your child's health care provider to find the best solution for your child.

Another name for middle ear fluid is otitis media with effusion. Some people also call it "glue ear." Otitis media means middle ear inflammation, and effusion means fluid.

About the Ear and Hearing

The ear has three parts-the outer ear, the middle ear, and the inner ear. The outer ear includes the part outside the head and the ear canal. The eardrum is a small circle of tissue about the size of a fingertip at the end of the ear canal. The middle ear is the space, usually filled with air, behind the eardrum. When a child has middle ear fluid, this is where it is found. A small tube-the eustachian tube-connects the middle ear to the back of the nose. Three tiny bones (the malleus, incus, and stapes) connect the eardrum through the middle ear to the inner ear. The inner ear is further inside the head ear, and is important for hearing and balance.

In a healthy ear, sound waves travel through the ear canal and make the eardrum move back and forth. This makes the three bones in the middle ear move. The movement of these bones sends sound waves across the middle ear to the inner ear. The inner ear sends the sound messages to the brain. But if the middle ear has fluid in it, then the eardrum and the bones cannot move well. This could cause your child to have trouble hearing.

What is Middle Ear Fluid?

If your child has middle car fluid, it means that a watery or mucous-like fluid has collected behind the eardrum. Many children get middle ear fluid during their early years. But middle ear fluid is not the same as an ear infection.

An Ear Infection usually happens in only one ear at a time. With a middle ear infection your child may have fever and sharp ear pain. When your health care provider looks into your child's ear, they might see a bulging red eardrum and some fluid in the middle ear.
Middle Ear Fluid is usually found in both ears at once. Most children do not have fever or pain with middle ear fluid. A special test is needed to look for this fluid (see How Do I Know If My Child is Affected By Middle Ear Fluid?).

What Causes Middle Ear Fluid?

Here are some things that may cause middle ear fluid to happen in your child.

Past ear infection. It is common for children to have middle ear infections. And some children with middle ear infection later have middle ear fluid.
Blockage of the eustachian tube.
Cold or flu.

There is no one cause for middle car fluid. Often, your child's health care provider will not know what caused the middle ear fluid.

Why Should I Be Worried About Middle Ear Fluid?

Most health care providers and parents worry that a child who has middle ear fluid in one or both ears may have trouble hearing. Experts do not know how much middle ear fluid affects hearing. Experts are not sure if hearing loss form middle ear fluid can cause delays in learning to talk, and sometimes later on, problems with school work. They do not know for sure what the long-term effects of middle ear fluid are.

How Can Middle Ear Fluid Be Prevented?

Recent studies show that children who live with smokers and who spend time in group child care have more car infections.

Because some children who have middle ear infections later get middle ear fluid, you might help prevent middle ear fluid by:

Keeping your child away from cigarette smoke.
Trying to keep your child away from playmates who are sick.

How Do I Know If My Child is Affected By Middle Ear Fluid?

Sometimes a child with middle ear fluid does not hear well. The most common complaint of parents whose child has middle ear fluid is that the child turns the sound up too loud or sits too close to the television set. Or sometimes the child does not seem to be paving attention.

Speak to your child's health care provider if you are concerned about your child's hearing. Often, middle ear fluid is found at a regular check-up.

Your child's health care provider may use the first two tests below to check for in middle ear fluid.

A Pneumatic Otoscope may be used to check for middle ear fluid. With this tool, the health care provider looks at the eardrum. The fluid in the middle ear may be seen behind the eardrum. Even when the fluid cannot be seen, the health care provider can test for fluid with this tool by blowing a puff of air onto the eardrum to see how well the eardrum moves. The child must be still for this test to work. The child will feel the otoscope in the ear, but the test does not hurt. This test does NOT measure the child's hearing level. Many health care providers feel that the pneumatic otoscope is the best test for middle ear fluid.
Tympanometry is another test for middle car fluid. Tympanometry helps the health care provider find out how well the eardrum moves. For tympanometry, a soft plug that is about the size of a person's little fingertip is placed snugly into the ear canal. The probe is connected to a machine called a tympanometer. The child hears a low noise for a short time while the machine records how the eardrum reacts. An eardrum with fluid behind it does not move as well as a normal eardrum.
Like the first test, the child must sit still for this test and will feel the probe in the car. The test does not hurt. Tympanometry does NOT measure hearing level.
Hearing Testing may be done to see how well your child hears. Hearing testing does not test for middle car fluid. In this case, it measures if the fluid is affecting your child's hearing level. The type of hearing test used depends on your child's age and listening ability.

Source: The Agency for Health Care Policy and Research, AHCPR Publication No. 94-0624 July 1994

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