Richmond's Ear, Nose and Throat Specialists

Middle Ear Fluid (Otitis Media)

Otitis media is an infection involving the middle ear space, which is behind the eardrum. The middle ear contains the small bones known as the hammer, anvil and stirrup, and is normally filled with air, which enters through the Eustachian tube. The Eustachian tube does not function well in young children, because it is much shorter and more horizontal than it is in adults.

The Eustachian tube may also swell shut as a result of a cold, allergy or exposure to tobacco smoke. Children who stay at day care centers have more frequent infections than do children who stay at home.

If air is not able to enter the middle ear through the Eustachian tube, then fluid may accumulate within the middle ear space. The fluid prevents movement of the eardrum, and causes a temporary hearing loss. This fluid may also become infected, resulting in fever, pain and irritability.

Antibiotic treatment speeds recovery and shortens the duration of the hearing loss. In the meantime, oral pain relievers such as acetaminophen (Tylenol®) or ibuprofen (Motrin®) are recommended for pain and fever. Follow the package directions, or ask your pediatrician for specific advice.

Pain and fever usually improve within a few days after starting properly selected antibiotics. The fluid may persist for several months following an infection. A follow-up examination is recommended to ensure that the fluid has resolved.

An alternative to antibiotic therapy is a procedure called bilateral myringotomy with tubes. Tubes are often recommended in children who have had four infections in the past 6 months or who have had persistent fluid for three months or more. Occasionally, tubes are placed urgently, in children with severe acute infections that are not responding to antibiotics. This procedure immediately improves hearing and relieves pain. In most children, tubes prevent further infections and lessen the need for prolonged antibiotics.

If your child’s doctor has recommended an ENT consultation or consideration of bilateral myringotomy with tubes, give us a call at 804 330-5501 or click here to request an appointment.


On your initial office visit, your child will be evaluated by an ear, nose and throat specialist. We will carefully examine the ear with an otoscope, and remove any wax that may be obstructing the canal. We may perform a hearing test and a tympanogram, which is a pressure test to assess the function of the Eustachian tube. Please bring a list of current medicines and allergies, as well as a list of your child’s infections during the past year.

If we recommend surgery and you decide to proceed, we will take care of scheduling and help you with insurance preauthorization. We will send your prescriptions electronically to your pharmacy.


The night before surgery, it is best not to eat or drink after midnight. Small children may be fed a light snack or formula 6 hours before surgery. Breast milk may be consumed up to 4 hours before surgery and small amounts of clear liquid may be taken up to two hours before surgery. Clear liquids include water, apple juice, black coffee and tea, but NOT orange juice or milk. Medications may be taken on schedule, with a sip of water if necessary.

On the morning of surgery, your child will be registered by the staff at the surgery center, and then evaluated by the nurses and doctors who will be helping us with your child’s care. The surgeon will greet you, verify identification, and confirm the planned surgery. Parents may escort their children to the threshold of the operating suite, and then return to wait in the pediatric perioperative area.

Children under 12 will be anesthetized by mask inhalation. Older children and adults may have an intravenous line started first. Once your child is comfortably asleep and breathing easily, the surgeon will examine the ears under a microscope. All wax and debris will be removed, and then a small cut is made in the front of the ear drum, well away from the delicate bones. Any fluid is evacuated, and a tube is gently inserted on each side. Your child will awaken within minutes after the gas is turned off. After a brief stay in the recovery room, your child will be returned to you. You probably won’t even have time to read the paper!

After Care

All effects of the anesthetic should wear off within an hour and your child may resume normal activity immediately. Antibiotic drops should be used as prescribed – we will make specific recommendations at the end of surgery. Your child may swim without ear plugs as long as the water is clean enough to drink. Avoid submerging your child’s ears in the bath tub, as soapy water penetrates the tubes quickly. Make an appointment to return to our office in about two weeks.


A certified nurse anesthetist will carefully monitor your child throughout the procedure. The risks of anesthesia are very small in healthy patients. You may discuss any concerns you have with the attending anesthesia physician prior to surgery. There is very little pain after the procedure. A few children will develop ear infections despite the placement of tubes. However, the tubes will allow the infected fluid to drain out of the ear. You will therefore be able to recognize the infection at home, and your child will be less likely to develop pain or fever. A permanent hole in the eardrum is quite rare. Occasionally it is necessary to repair the hole after the tube falls out. It is far more common for children to return for a second set of tubes before they out-grow their tendency to develop the ear infections.


Antibiotics are usually effective and safe for acute infections. Occasionally, daily antibiotic treatment through the cold and flu season has been effective in preventing acute otitis media. However, antibiotics become less effective with frequent use, because the bacteria develop resistance to the medication. Children may also accumulate allergies or other side effects to antibiotics, thereby limiting the choices of medication available in the future.

Antibiotics rarely relieve fluid that has been present for longer than three months. Chronic fluid is more likely due to allergies or large adenoids. Studies have shown that children who have their adenoids out are 40% less likely to need tubes replaced in the future.

Allergy testing is frequently recommended for children over 4 years old with persistent fluid in the ears. If surgery is necessary, the allergy test can be performed while your child is anesthetized.