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Fluid in the ear can be difficult for your doctor to diagnose. There are no obvious symptoms.

Fluid in the ear is not an ear infection and the fluid trapped inside the ear doesn't usually contain germs. So your child is unlikely to get pain or a high temperature.

But if you suspect your child cannot hear properly and may have fluid in the ear, you should take him or her to your doctor.

Your doctor will probably want to know:¹

• Whether you have noticed signs of hearing loss in your child
• Whether there have been changes in your child's behavior at home or school
• Whether he or she has had symptoms that could indicate a recent infection, such as pain in the ear or fever (many children get fluid in the ear after an ear infection)
• Whether he or she has had any colds or thick nasal mucus recently.

Your doctor will also want to speak to your child to find out if he or she has any problems hearing.¹

Your doctor will look inside your child's ears using a tool called an otoscope, which is like a microscope. This allows the doctor to look for signs of fluid inside the ear. He or she will check to see if your child's eardrum looks dull (a healthy eardrum looks shiny). He or she will also check for any air bubbles or fluid behind the eardrum. However this test does not always detect fluid in the ear. Even if the eardrum looks normal, your child could still have fluid in the ear.¹

Your doctor may also carry out a test called a tympanometry (a test that measures how much the eardrum moves), so they can know for certain if your child has fluid in the ear.² For more information about this test, see More about tests for fluid in the ear.

There is also a special type of otoscopy, called pneumatic otoscopy, to see how well each eardrum is working. The test changes the pressure inside the ear canal and lets the doctor see if the eardrum responds by moving. If the eardrum is not moving very much, it suggests there is fluid inside the ear.

Pneumatic otoscopy is very accurate when done by a doctor who is specially trained in this test. Guidelines for doctors say that pneumatic otoscopy is the best way to find out what is happening in your child's middle ear.²

If your child has fluid in the ear for a long time, or it keeps coming back, your doctor may decide he or she should see a specialist to find out more and to see if he or she needs treatment. A specialist can carry out more tests to find out for certain if your child has fluid in the ear and to find out how bad the hearing loss is. Your child may either be referred to an ear, nose and throat (ENT) doctor or hearing specialist (audiologist).

To learn more, see More about tests for fluid in the ear.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.