Please note: This information was current at the time of publication but now may be out of date. This handout provides a general overview and may not apply to everyone. 

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Am Fam Physician. 1998;58(5):1123

See related article on upper respiratory tract infections in children.

What is otitis media with effusion?

Otitis media with effusion is an ear infection with fluid in the middle (inner) ear. (Effusion is another word for fluid.) This fluid usually doesn't bother children. It almost always goes away on its own. So, this kind of ear infection doesn't have to be treated with antibiotics, unless the fluid doesn't go away.

What causes this kind of ear infection?

Fluid may build up in the middle ear for two reasons. First, when a child has a cold, the middle ear may produce fluid just like the nose does, but the fluid doesn't drain out of the middle ear as easily as it does from the nose. Second, children who have a “regular” ear infection could have otitis media with effusion the next time, if the fluid stays in the middle ear for a long time.

How is this kind of ear infection treated?

The best treatment is to let the fluid go away by itself.

Are antibiotics ever needed for an ear infection with fluid?

Yes. If the fluid is still there after a few months and is causing hearing loss or problems in both ears, antibiotics may help some children. For this reason, your child's ears should be checked a few months after an ear infection. If the fluid is still there, a hearing test may be the next step.

Why not just try antibiotics right now?

Giving your child unnecessary antibiotics can be harmful. After each course of antibiotics, the germs in the nose and throat are more likely to become resistant. Resistant germs can't be killed by the usual antibiotics. More expensive and powerful antibiotics have to be used. Some of these antibiotics must be given in the hospital. Since fluid in the ears doesn't usually bother children, it's better to wait and only give antibiotics when they're necessary.

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