My 5-Year-Old Daughter Has Had Chronic Fluid In Both Ears?

Does She Need To Be Evaluated For Allergies?

Acute middle ear infections (acute otitis media) usually follow colds, and occasionally the fluid in the middle ear space persists for long periods of time. Chronic middle ear fluid, referred to as  otitis media with effusion,is defined as mild middle ear inflammation with fluid but without symptoms of fever, pain, and infection. The most common symptoms of chronic middle ear fluid in infants are irritability or sleep disturbances, failure to respond appropriately to voice or environmental sounds, balance problems, unexplained clumsiness, delayed development of gross motor skills, speech or language, and other signs of hearing loss (such as listening to the television at a very high volume).

Common complaints in a 5-year-old child with persistent middle ear fluid would be rubbing of the ears, mild intermittent ear pain, full-ness or “popping” of the ears, and problems with school performance. However, in approximately half of children with persistent middle ear fluid, neither the children nor their parents describe significant complaints. Many factors contribute to the chances that a child will develop chronic middle ear fluid, including the age and genetic background of the child, shape of the middle ear structures, as well as exposure to viral infections, airborne allergens, and irritants (such as tobacco smoke).

Many studies have shown that children with nasal allergies are at increased risk for developing chronic middle ear fluid,particularly those older than 3 years of age. While the connection between allergies and middle ear fluid are not completely clear, we do understand that nasal allergy can lead to swelling of the eustachian tubes, which alters the pressure within the middle ear and predisposes the ear space to fluid accumulation. In children with chronic ear fluid who also have persistent nasal symptoms, it is useful to perform allergy tests. If the tests show positive results, I would counsel the family regarding allergen avoidance measures and prescribe appropriate medical treatment. If these steps do not alleviate the child’s allergy symptoms, I would consider prescribing allergy immunotherapy. In the event that a patient has no symptoms of rhinitis, I would not pursue allergy testing; nor would I prescribe anti-allergic treatment. 

Otitis media with  effusion

Inflammation of the middle ear with result-ant fluid collection in the middle ear space.