Is your child not hearing you the way they used to?

What is fluid in the ear?

The middle ear is a small space just behind the eardrum that is normally filled with air. It is ventilated by the Eustachian tube, which opens into the back of the nose. When the Eustachian tube does not work well enough, the air in the middle ear is absorbed and is gradually replaced by fluid. This is called fluid in the ear; its medical name is otitis media with effusion, also known as serous otitis or glue ear.

Fluid in the ear is very common, especially in childhood. Most children experience it at least once before they reach school age. Because it usually causes no pain or fever, it is hard to notice. The only sign may be reduced hearing, and this is often picked up by parents or teachers.

A large share of fluid build-up clears up on its own within a few weeks or months. However, long-lasting fluid can affect hearing, speech development and school performance. In that case, ear tube insertion is one of the most effective treatments for draining the fluid and ventilating the middle ear again.

Symptoms of fluid in the ear

Symptoms can differ depending on the child's age. Young children cannot describe hearing problems, so changes in behavior are often the first clue. Older children and adults, on the other hand, talk about a feeling of fullness or blockage in the ear.

The most common symptom is reduced hearing. Fluid in the ear should be considered in children who respond late when called, often ask "what?", turn up the TV, or struggle to follow conversation in crowded places. Speech lagging behind that of peers, poor concentration, a drop in school performance and balance problems may also be seen.

Some children may also have frequently recurring middle ear infections, ear tugging, restless sleep and ear pain that gets worse at night. In adults, a feeling of fullness in the ear, hearing their own voice inside the ear, crackling sounds and mild hearing loss are the main symptoms.

Why does fluid build up in the ear?

The main cause of fluid in the ear is an Eustachian tube that does not work well enough. In children the Eustachian tube is shorter, more horizontal and narrower than in adults, so it gets blocked easily. This explains why children are more prone to this problem.

Enlarged adenoids are one of the most common associated conditions. Adenoids growing at the back of the nose narrow the opening of the Eustachian tube and disrupt ventilation of the middle ear. Frequent upper respiratory infections, allergic rhinitis, chronic sinusitis and exposure to second-hand smoke also increase the risk of fluid build-up.

In some conditions, such as cleft palate and Down syndrome, Eustachian tube function is weaker from birth, so fluid in the ear is more frequent and lasts longer. In adults, air travel, diving, reflux and masses at the back of the nose can be the cause. You can find more information about Eustachian tube blockage in our article how to unblock a blocked Eustachian tube.

How is fluid in the ear diagnosed?

The first step in diagnosis is examining the eardrum with an otoscope. The color and mobility of the eardrum are changed; a yellowish fluid, an air-fluid level or air bubbles may be seen behind it. With an experienced examination, these findings are usually easy to recognize.

To confirm the diagnosis, a short, painless test called tympanometry is done. This test measures how well the eardrum moves; when there is fluid in the middle ear, the eardrum moves less and the test result changes accordingly. Age-appropriate hearing tests are done to determine how much hearing is affected. In young children, hearing can be measured using play-based methods.

The examination also assesses associated conditions such as enlarged adenoids, allergy and nasal blockage, because the success of treatment depends on also addressing the cause of the fluid build-up. You can find more detailed information about middle ear fluid in our article on fluid in the middle ear.

Treatment approach: monitoring or a tube?

A large share of middle ear fluid clears up on its own within the first three months. That is why, in children whose hearing is not markedly affected and who have no risk factors, the first approach is monitoring. During this period there are regular check-ups, hearing is followed, and any associated allergy or nasal problems are treated.

If the fluid lasts longer than three months and there is hearing loss, speech delay, difficulty at school or structural changes in the eardrum, the treatment plan changes. In this case, ear tube insertion is the most effective and most commonly used treatment. Tube treatment may also be considered in children with frequently recurring middle ear infections.

In children at risk for hearing or speech development, for example those with previous hearing loss or developmental delay, the monitoring period may be kept shorter. The decision is made separately and individually for each child. You can find the general framework of international recommendations on the MedlinePlus ear tube page.

How is ear tube insertion performed?

In children the procedure is performed under general anesthesia; the child is asleep and feels no pain. The eardrum is reached through the ear canal with the help of a microscope, and a very small opening is made in it. The fluid in the middle ear is drained through this opening, and a small ventilation tube is then placed in it.

The procedure usually takes 15 to 20 minutes, and no external incision is made. The tube connects the middle ear with the outside, keeping it ventilated and preventing new fluid from building up. After waking, the child usually goes home the same day following a short period of observation.

If enlarged adenoids are also present, the adenoids can be removed under the same anesthesia. This approach reduces the risk of the fluid coming back. To learn about the role of the adenoids, see our adenoids page.

Preparing for the procedure

Before the procedure, your child's general health is assessed and a meeting with the anesthesia team is arranged. It is important to share the medicines your child takes, their allergies, and whether there has been any previous problem with anesthesia. On the night before the procedure, eating and drinking stop after a set time.

Explaining calmly to your child that they will go to the hospital, sleep for a short time and that you will be with them when they wake up reduces their anxiety. Bringing a favorite toy also helps them feel safe in an unfamiliar setting. If the child has an illness with fever, the procedure is usually postponed for a few days.

The day of the procedure

On the day of the procedure, your child is welcomed by the anesthesia team, and you are often allowed to stay with them until anesthesia begins. Because the procedure is short, the waiting time is not long either. After waking, your child stays in the observation room for a while and is discharged once they can drink and feel well.

After returning home, it is enough for your child to spend the rest of the day resting. Most children are back to their usual energy the next day. It is important to use the ear drops you are given as recommended and not to miss the follow-up appointment.

Types of tubes

Ear tubes are generally divided into two groups: short-term and long-term. Short-term tubes are enough for most children; they stay in the ear for anywhere from a few months to a year and a half and then fall out on their own. Long-term tubes are preferred when fluid keeps coming back or when the Eustachian tube problem is expected to last a long time.

Which tube is used depends on the child's age, how long the fluid has been present, whether tubes have been inserted before, and any associated conditions. Tubes are made of small, light materials that are compatible with ear tissue.

Hearing after the tube is inserted

Because the fluid is drained, hearing improves quickly in most children. Families often notice in the first days that their child responds to sounds faster, asks "what?" less often and starts turning the TV volume down. Children with delayed speech development may also show clear progress in the following months.

If hearing does not improve as expected after the tube is inserted, other possible causes of hearing loss are investigated. That is why the hearing test is repeated at check-ups after tube insertion. Rarely, permanent changes in the eardrum or hearing loss related to the inner ear may also be present; these are assessed separately.

Care after the tube and things to watch for

In the first days after the tube is inserted, there may be a slight, bloody or watery discharge from the ear. This usually clears up on its own within a short time. Pain is usually mild and can be controlled with simple painkillers. The child can usually return to school or nursery the next day.

While the tube is in place, protecting the ear from water is recommended. When bathing, cotton wool with an oily cream or special earplugs can be used in the ear. It is especially important to keep soapy and dirty water out of the ear. Advice about swimming varies with the child's age and the type of water, and is planned together at the check-up.

If a long-lasting, foul-smelling or dark discharge comes from the ear while the tube is in place, an infection may have developed. In this case you should contact your doctor; antibiotic ear drops are usually enough. Regular check-ups are important to make sure the tube is in place and to monitor the health of the ear.

When does an ear tube fall out?

Short-term tubes usually fall out on their own between 6 and 18 months. The eardrum naturally pushes the tube out, and the opening left by the tube usually closes on its own. The tube mostly falls out without being noticed; sometimes a small tube may be seen in the ear canal or on the pillow.

There is usually no clear sign that the tube has fallen out. That is why check-ups are important. If, after the tube has fallen out, hearing decreases again, there is a feeling of fullness in the ear or ear infections recur, fluid is thought to have built up again and the ear is re-assessed.

In some children, the need for tubes may come back until Eustachian tube function matures with age. Tubes that stay in for a long time without falling out are assessed at check-ups and removed if needed.

Check-ups and long-term follow-up

The first check-up after the tube is inserted is usually done within a few weeks. At this check-up, it is assessed whether the tube is in place and open and whether there is any discharge from the ear, and the hearing test is repeated. Further check-ups continue at regular intervals for as long as the tube stays in the ear.

It is also valuable to share your observations at check-ups about your child's speech development, how they are doing at school and their general health. This information helps us understand how successful the treatment has been and, if needed, plan additional support such as speech and language therapy in good time.

At least one check-up after the tube has fallen out is also recommended. At this examination, we check whether the eardrum has closed and whether fluid has built up again in the middle ear. Air travel is generally more comfortable for children with tubes, because the tube allows the pressure in the middle ear to equalize easily. You can raise any question at the check-ups and ask for an earlier appointment when needed. Regular follow-up allows possible problems to be noticed early and helps protect your child's hearing in the long term.

Risks of ear tube insertion

Ear tube insertion is a safe and commonly performed procedure; even so, as with any procedure, there are some risks. The most common is discharge from the ear while the tube is in place, which usually clears up easily with drops.

Other possible outcomes are a small hole remaining in the eardrum after the tube falls out, white scar tissue forming on the eardrum, and the tube falling out earlier than expected. A permanent hole is rare and can be repaired with a small procedure if needed. Risks related to anesthesia are also kept to a minimum by assessing the child's general health beforehand.

Long-lasting fluid that is not treated also carries risks: speech delay due to hearing loss, collapse of the eardrum, a retraction pocket and, later on, serious problems such as cholesteatoma can develop. The treatment decision is made by carefully weighing these two sides against each other.

The link between adenoids and fluid in the ear

In children, the most common associated cause of fluid in the ear is enlarged adenoids. Enlarged adenoids narrow the opening of the Eustachian tube at the back of the nose, disrupting ventilation of the middle ear and making it easier for germs from the nose to reach the middle ear.

That is why the adenoids are always assessed in children with recurrent fluid build-up, or whose fluid comes back even though tubes have been inserted before. When needed, removing the adenoids at the same time as ear tube insertion reduces the chance of the problem coming back.

Allergic rhinitis and fluid in the ear

Allergic rhinitis can make the tissues in the nose and nasopharynx swell and disrupt how the Eustachian tube works. Fluid in the ear may be more common in children with seasonal allergies. In these children, getting the allergy under control is an important part of treatment.

Allergy tests, advice on avoiding allergens and nasal sprays may be part of the treatment plan. When the allergy is under control, the chance of fluid building up again decreases.

Effect on school performance

Fluid in the ear that goes unnoticed makes it harder for a child to hear the teacher in class. This can show itself as poor concentration, lack of interest in lessons and a drop in school performance. Sometimes these children may be wrongly diagnosed with attention deficit.

Hearing problems noticed by teachers or parents should always be assessed. A simple ear examination and hearing test can make an important difference in a child's school life. You can find more information about ear infections in children in our article on ear infections in children.

Fluid in the ear in adults

Fluid in the ear is less common in adults than in children and may have different causes. Sudden pressure changes after air travel or diving, upper respiratory infections, allergies and reflux are among the common causes. Most cases clear up on their own or with simple treatment.

In adults, fluid that is one-sided and long-lasting in particular should always be assessed in detail. In this case, the back of the nose is examined endoscopically to make sure there is no other underlying cause. If the fluid persists for a long time, ear tubes can also be inserted in adults; the procedure can often be done under local anesthesia.

When should you see a specialist?

If your child responds late when you call them, keeps turning up the TV, has speech that lags behind their peers or has frequent ear infections, it is recommended that you see an ear, nose and throat specialist. Feedback from teachers about attention or hearing should also be assessed.

Prof. Dr. Mustafa Deniz Yılmaz assesses patients with fluid in the ear through a detailed examination, tympanometry and age-appropriate hearing tests. Whether monitoring or tube treatment is needed is determined individually for each patient. By completing the short assessment at the top of this page, you can see where you stand and contact us through the pre-assessment form.