Serous Otitis Media (Fluid in the Ears)

Symptoms, Diagnosis, and Treatment

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Ear drum with fluid behind it
Ear drum with fluid behind it. "Adult Serous Otitis Media" by Michael Hake MD - Own work. Licensed under CC BY-SA 4.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Adult_Serous_Otitis_Media.jpg#/media/File:Adult_Serous_Otitis_Media.jpg

Serous otitis media (SOM), also known as otitis media with effusion (OME), fluid in the ear, middle ear effusion (MEE), or secretory otitis media, is a condition in which fluid resides in the middle ear. "Serous" refers to the type of fluid that is collecting inside the middle ear. Serous fluid is usually straw (yellowish) colored liquid or mucus. In this case, there is eustachian tube (auditory tube) dysfunction that is not draining the fluid as it normally should.

Risk Factors

The most common group of people at risk for getting serous otitis media are children. Particularly newborns, where approximately six out of 10 newborns may fail their hearing test due to fluid in the ear. This will usually resolve in a month. If it is unresolved, however, your child's doctor may need to help remove the fluid.

Common reasons for this includes the difference in the eustachian tube between children and adults. In children, the tube is both shorter and more level, making it less likely to drain fluid. Whereas in adults, the tube is longer and has more of a sloped angle allowing gravity to assist in draining the middle ear. Children are most likely to have fluid in the middle ear between six and 11 months, and risk decreases as your child gets older. Most children will have had at least one episode of fluid in the middle ear before the reach school-age. While it is most prevalent in children, adults can still have issues with serous otitis media, but it is not as common.

Risk can be impacted by disorders that your child is born with that can make them particularly prone to getting fluid in the middle ear space including:

  • Cleft palate
  • Autism spectrum disorders
  • Developmental disorders
  • Down syndrome
  • Speech and other language delays
  • Hearing disorders (not related to the fluid)
  • Blindness
  • Other congenital (present at birth) facial bone abnormalities

There are also many common problems that children face that can also make them prone to developing serous otitis media including:

Symptoms

You may not always experience symptoms with serous otitis media, which means that you may not ever know that you have it unless it is noticed during a doctor's physical exam. However, sometimes there is enough fluid in the middle ear space that you will notice one or more of the following symptoms:

  • Pain
  • Hearing loss
  • Ear fullness
  • Child pulling at their ear
  • Child has a change in behavior

Young children may be difficult for you to tell that there is an issue with their ears. If you notice a prolonged behavior change, it is usually best to have a doctor evaluate them for any problems with their ears like serous otitis media

Serous Otitis Media vs. Ear Infection

Be aware that serous otitis media is not an ear infection, otherwise known as acute otitis media. While both have fluid in the middle ear space, fluid with acute otitis media is infected, whereas that is not the case with serous otitis media.

An ear infection will change the shape of the ear drum, making it bulge toward the outside of the ear.

With serous otitis media, the shape isn't really changed. Your doctor can look for this when making a diagnosis.

You will also notice a difference in symptoms. An ear infection will almost always have a fever associated with it. The level of pain noticed will also be different. While you can experience pain with serous otitis media, the level of pain is worse with an ear infection.

Diagnosis

Your doctor can diagnose serous otitis media normally by using either: tympanometry or pneumatic otoscopy. Tympanometry is test that measures the ear drums response to sound waves. Since fluid behind the ear drum will affect the ability of the ear drum to move normally, tympanometry can be useful in determining fluid in the ear.

However pneumatic otoscopy is more accurate in diagnosing fluid in the ear. The doctor will use an otoscope that has a bulb syringe attached, which allows them to evaluate how well the ear drum reacts to the pressure change when the bulb syringe is squeezed. Fluid can also be determined by observing for color changes of the ear drum, representing changes behind the ear drum.

Duration

Serous otitis media usually will last around three months. If fluid in the middle ear persists longer than three months, your doctor will usually want to treat the fluid more aggressively. Failure to correct prolonged fluid in the ear may result in:

Treatment

Serous otitis media will usually resolve without any intervention. If allergies are a suspected reason, then your doctor will usually prescribe an antihistamine (like Zyrtec or Allegra) to be tried during a three-month monitoring period. If the fluid behind the ear drum is not resolved within three months, it is generally best for your doctor to remove the fluid by surgically placing an ear tube.

Prior to placing the ear tubes, your doctor will also look in the back of your child's throat to determine if the adenoids may be blocking the eustachian tube. If the adenoids are enlarged, your doctor may recommend an adenoidectomy to prevent blockage of the eustachian tube from causing further fluid collecting in the middle ear.

Sources:

Casselbrandt, M.L. & Mandel, E.M. (2015). Cummings Otolaryngology, 6th ed.: Acute Otitis Media and Otitis Media with Effusion. Saunders:Elsevier.

ExitCare. (2015). Patient Education: Serous Otitis Media. Accessed on 2/26/2016 from http://www.clinicalkey.com (subsription required)

O’Connor, S.S., Coggins, R., Gagnon, L., Rosenfeld, R.M., Shin, J.J. & Walsh, S.A. (2016). Otolaryngol Head Neck Surg. 154(2):215-225. doi: 10.1177/0194599815624409

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