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Does your child pay less attention or seem more withdrawn than normal? Or has he or she become fidgety or disruptive? If so, your child could be having hearing problems because of fluid trapped inside his or her ear.

Doctors have lots of names for this condition. You may hear it called otitis media with effusion, or OME. More commonly it's known as fluid in the ear.

The condition is difficult to spot, although it often follows an ear infection or a cold. It doesn't cause obvious symptoms such as pain or fever. And you can't see the fluid because it doesn't come out of the ear.

Fluid in the ear most often affects children under age two years old, although older children and adults can get it, too. It's common in children from as young as six months to as old as six years old.¹

Fluid in the ear is very common among young children, especially between the ages of one year old and three years old.¹ But older children and adults can get it too. About 4 in every 5 children have had fluid in the ear by the time they are four years old.¹

The good news about fluid in the ear is that it often clears up on its own within a few months. But in some children, it can drag on or come back, so the child's hearing is affected for long periods. If your child is learning to talk, fluid in the ear may delay his or her speech. And if your child can't hear properly, it can affect his or her behavior and cause problems at school.² If this happens, it's important to get treatment.

• Fluid in the ear is very common in young children.³ It's the most common cause of poor hearing in children.
• Fluid in the ear is difficult to spot because it doesn't have any obvious symptoms. But it often follows an ear infection or a cold.
• Most children with fluid in the ear get better on their own, usually within a few months.
• Some children get fluid in the ear for long periods and some keep on getting it. This can affect hearing and the learning of speech. If this happens, it's important to get treatment.
• The main treatment for fluid in the ear is surgery to put in tubes.

To understand what happens when your child gets fluid in the ear, it's helpful to know a little about how the ears work.³

• Your outer ear is the part you can see. It 'catches' sounds.
• The hole in the middle of your ear is your ear canal. It carries sounds into your ear.
• Stretched across the end of your ear canal is your eardrum. This thin tissue moves when sounds reach it and the sounds are passed on.
• Behind your eardrum is your middle ear. It's usually filled with air, although it also makes a thin, watery fluid. It has three tiny bones that move when sounds reach them.
• The bones carry sounds to your inner ear. Here, special nerves pick up the sounds and send signals to your brain. (Your inner ear also helps you keep your balance.)
• Your brain translates these signals and recognizes them as sounds.
• Your eustachian tube connects your middle ear to the back of your nose (just above the roof of your mouth). It keeps the air pressure on both sides of the eardrum equal. This tube is closed most of the time, but it opens briefly when you swallow or yawn. This lets air flow into the tube, so that the air pressure inside your middle ear and outside your head is the same.
• Your eustachian tube also lets any fluid in your middle ear drain off down your throat. This helps to remove any germs that get into your middle ear.

Children's adenoids are at the back of their nose, near the opening of their eustachian tubes. The adenoids are made of special tissue that helps your child's body fight infection. When most children are around three years old, their adenoids will start to shrink. Eventually, their adenoids will disappear altogether.

In some young children the adenoids can get infected. This can stop the eustachian tubes from working properly and may be part of the reason why a child gets fluid in the ear.

Your tonsils are two small mounds at the back of your throat. Like the adenoids, they are made of special tissue that helps your body fight infection. But sometimes your tonsils can become inflamed and swollen. But doctors don't think that having inflamed tonsils causes children to get fluid in the ear.

A child gets fluid in the ear when a thick, sticky fluid builds up inside his or her ear.⁴

• Normally the middle ear is filled with air. But when you have fluid in the ear, this area fills with fluid. The fluid is a bit like the thick mucus that can get stuck in your throat.⁵
• The fluid can stop the eardrum and the three small bones from moving freely, so they can't carry sounds to the inner ear.
• This may mean your child cannot hear properly.
• Your child may get fluid inside one or both ears. About 40 percent of children with fluid in the ear have it in both ears.
• In many children fluid in the ear clears up after a short period. But in some children the fluid doesn't go away. About 4 in 5 children still have fluid in the ear after a month,¹ and over half still have fluid in the ear after three months.^{1 5} About 1 in 20 pre-school children still have fluid in the ear after a year.^{5 6}

Doctors don't know exactly why fluid in the ear happens.¹ But there are some things that seem to be linked to fluid in the ear.

• Fluid in the ear often follows an ear infection or another infection (such as a cold or flu).² So it may be that germs from the infection get into the middle ear and cause swelling (inflammation). If this happens, the fluid becomes thicker and stickier than usual.
• Ear infections are common in young children. Over two-thirds of children have had an ear infection by the time they are three years old.⁷ Children usually recover from the infection within days, but the fluid can stay trapped in their middle ear.
• Doctors also think that fluid in the ear may happen because of the eustachian tubes not working properly. The tube may not open properly or drain off fluid as it normally does.¹
• In young children, the eustachian tubes are far smaller than those of adults. So they can easily get blocked by fluid. The tubes are also more horizontal, making it easier for germs to travel along them.
• If your child has had an infection, his or her adenoids can become infected and swollen. They stop the eustachian tubes working properly and make the fluid in the ear worse.

Some things make it more likely that a child will get fluid in the ear. These are called risk factors. The most common risk factors for fluid in the ear in young children are:

• Going to daycare
• Being given formula milk (rather than breast milk) as a baby
• Having parents who smoke
• Coming from a large family
• Having a lot of infections at a young age.

To learn more, see Risk factors for fluid in the ear.

Even if your child has a higher chance than normal of getting fluid in the ear, there are things you can do to reduce the risk. To learn more, see How to help keep your child's ears healthy.

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.