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Fluid in the middle ear
Last reviewed: 04.07.2025
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Fluid in the middle ear may be observed in the following conditions:
[ Acute purulent inflammation of the middle ear
As a rule, it occurs following an upper respiratory tract infection. People of any age are affected, but children are more often affected. The patient complains of ear pain, fever, a feeling of pressure in the ear, and hearing loss. Otoscopy shows a hyperemic eardrum. Serous exudate accumulates in the middle ear cavity, which then becomes purulent. The eardrum becomes dull and can bulge. If the eardrum is perforated, the patient feels relief, and the body temperature drops. In uncomplicated cases (if the eardrum is perforated, then recovery occurs), discharge from the ear gradually becomes serous, and then stops completely. Most often, the causative agent is pneumococcus, but the etiologic microorganisms can also be streptococci, staphylococci, and Haemophilus.
In adult patients, the drugs of choice are penicillin G (600 mg intramuscularly initially), followed by penicillin V (500 mg every 6 hours orally). For children under 5 years of age, amoxicillin is recommended at a rate of 30-40 mg/kg per day orally for 7 days, since at this age the pathogen is most often Haemophilus. The point is also that penicillin does not enter the middle ear cavity in concentrations toxic to Haemophilus.
About 5% of Haemophilus strains are resistant to amoxicillin but sensitive to co-trimoxazole, but co-trimoxazole has not shown better results in studies. It seems that short, 3-day, courses of antibiotic therapy are quite effective in such cases. The use of decongestants does not affect the general course of the disease. The patient should be given a sufficient dose of analgesics, such as paracetamol at a rate of 12 mg / kg every 6 hours orally. Very rarely, in case of pain and sudden bulging of the eardrum, incision (myrigotomy) is required. Such a patient should have his hearing checked after 6 weeks.
Rare complications of otitis media.Mastoiditis (1-5% of cases before antibiotic use), petrositis, labyrinthitis, facial nerve paralysis, meningitis, subdural and extradural abscesses, brain abscesses.
Exudative otitis, serous otitis media
Non-purulent chronic effusions in the middle ear cavity occur when the Eustachian tubes are blocked. The exudate in the middle ear can be watery (serous) or mucous and sticky. In the latter cases, the exudate in children is usually infected, and this disease is called exudative otitis ("glued ear"). Exudative otitis is the most common cause of hearing loss in children, which can cause serious delays in school. "Glued ear" does not hurt, and the presence of a pathological process may not be suspected, although it is a common complication of otitis media - 10% of children after an acute episode still have effusion in the middle ear after 3 months. The eardrum loses its shine and becomes somewhat retracted. The presence of radially diverging vessels on its surface indicates that there is fluid behind it. This fluid can be colorless or yellowish, with air bubbles. In such cases, bacteria can be cultured from the middle ear in 33% of patients (and antibiotics may be helpful).
Decongestants are usually ineffective in "glued ear". If the fluid in the middle ear cavity is longer than 6 weeks, then it is necessary to consider performing myriotomy, suctioning the fluid and installing a special tube for ventilation of the middle ear cavity - all this helps to restore hearing. Adenoidectomy is equally effective, it prevents the development of tympanosclerosis (thickening of the eardrum) after the installation of a ventilation tube or after a repeat operation, if the need for it arises very quickly. However, adenoidectomy is accompanied by a small postoperative mortality.
In adults, in such cases, a tumor localized in the nasopharyngeal space should be excluded.