Chronic otitis media (secretory otitis media, often called "fluid in the middle ear" or "glue ear") is a condition in which secretions accumulate in the middle ear without signs of acute infection. The fluid dampens the movements of the eardrum and causes reduced hearing, pressure and sometimes pain - especially when lying down. The condition is very common in children of institutional age, but adults can also be affected. In most people, the fluid disappears on its own within three months, but if it persists, treatment with drains may be relevant.

What is the difference between acute and chronic otitis media?

The difference is whether there is an active infection. Acute otitis media is an infection of the middle ear with fever, ear pain and often discharge from the ear when the eardrum ruptures. Chronic otitis media – more precisely fluid in the middle ear (secretory otitis media) – on the other hand, is not an actual infection, but secretions that remain in the middle ear after a cold or an acute otitis media. The two conditions are stages in the same process, and acute otitis media can develop into persistent fluid in the middle ear.

What are the symptoms of fluid in the middle ear?

The symptoms are due to the fluid impairing hearing and increasing pressure in the middle ear. In adults, it is typically felt as reduced hearing, a feeling of pressure or "plug" in the ear and sometimes mild dizziness. In children, it can be difficult to detect because the condition is often painless. Signs in children include that the child has poor hearing, speaks loudly, sits close to the television, seems inattentive or has delayed language development. Many children sleep restlessly, wake up at night and touch their ears because the pressure increases when they lie down.

What causes fluid in the middle ear?

The most common cause is a cold, where the Eustachian tube, which connects the middle ear to the pharynx, swells up and closes. The middle ear can no longer equalize pressure, negative pressure occurs, and the mucous membrane begins to produce a sticky secretion - hence the English name "glue ear". In children, the closure is often due to enlarged childhood polyps that block the Eustachian tube. Therefore, treating the childhood polyps can be part of the solution. In adults, persistent unilateral fluid in the middle ear should always be examined by a specialist to rule out other causes.

How is fluid in the middle ear examined?

The examination is carried out by an ear, nose and throat specialist and is based on an examination of the ear using a microscope, possibly supplemented with a hearing test and a pressure measurement of the middle ear (tympanometry). The pressure measurement shows whether there is fluid behind the eardrum, and the hearing test reveals how much hearing is affected. Based on the examination and medical history, the specialist assesses whether the condition can be waited out or whether treatment is needed.

How is chronic otitis media treated?

Treatment depends on how long the condition has lasted and how much it bothers you. Since fluid in the middle ear often disappears on its own, an observation period of about three months is typically offered first. If the fluid persists and affects hearing, the most effective treatment is to place a drain in the eardrum, which immediately restores normal pressure and allows the fluid to drain. In children, where enlarged tympanic polyps are part of the cause, removal of tympanic polyps can be combined with drainage treatment. According to the Weekly for Doctors, drainage treatment immediately improves hearing and reduces the risk of repeated otitis media.

When should you seek medical attention?

You should seek medical attention when hearing loss or pressure in the ear persists for more than a few weeks, or when a child has poor hearing, speaks loudly, or seems inattentive for a long time. Adults should always have persistent fluid in one ear examined by a specialist. In the event of acute, severe ear pain with fever, you should contact your doctor or an emergency room doctor.

Fluid in the middle ear at Charlottenlund Private Hospital

At Charlottenlund Private Hospital, children and adults with fluid in the middle ear are examined and treated by specialists in ear, nose and throat diseases. The examination includes microscopy of the ear, hearing test and pressure measurement, and the treatment is planned individually – from observation to the installation of drains. You will find an overview of all departments on our department page.

Sources:

- Danish Society of Otorhinolaryngology (DSOHH): NKR for treatment with eardrum drain. Weekly for Doctors: Otitis media – about secretory otitis media, diagnostics and drain treatment.