May 29, 2023

How does fluid get into the middle ear? Why can’t middle ear fluid be left alone? This is a video explanation of the causes of middle ear fluid, what happens to that fluid over time, and the damage it can cause to the ear and the health of the patient. This video is for educational purposes only. If you are experiencing health problems, see your local ENT specialist. More videos and information available on my channel or at

Hi i’m doctor key forth and today i’m going to talk about fluid in the middle ear many times i’m asked how does fluid get into the middle here and the answer is always that it started with an infection it could have been a viral infection or it could have been a bacterial infection or even a combination of both if we think about the nose whenever we get infected

In our nose like a common cold or a sinus infection we produce fluid that is the body’s typical reaction to a virus or a bacteria is to produce a mucous type discharge to wash away that pathogen or that invader well the middle ear lining is no different than the nose lining in that sense that when there’s an invader a bacteria or a virus it will produce fluid to

Try to wash that away typically that fluid is going to be drained out of the ear by the eustachian tube down out and into the back of the nose but if this eustachian tube is swollen or if it’s not working because a child is young hasn’t properly developed yet then that eustachian tube will not allow fluid to drain and fluid then is stuck in the middle ear cavity

Now typically if you treat with an antibiotic the bacteria that caused that middle of fluid would usually respond to that antibiotic but it can leave fluid behind in the middle ear and oftentimes we can look and see that that fluid is not infected it’s just stuck there in the middle ear now here’s the thing about middle ear fluid as it sits there over time it gets

Thicker and thicker and thicker so if we looked at fluid that’s in the ear for let’s say one week we would find that that fluid is very thin and that thin fluid produces a little bit of muffling of the hearing if that fluid can’t drain down and out the eustachian tube and it sits there let’s say for two to four weeks what we’ll see is that fluid goes from thin to

Thick and now a very mild hearing loss becomes a moderate hearing loss because of this thick fluid and unfortunately we have the best chance of draining that fluid down and out the eustachian tube when it’s thin as it gets thicker there’s less and less chance because it’s harder to drain a thicker fluid down a swollen and small eustachian tube and in some cases

That fluid will sit there for a long time let’s say months when that fluid sits there for months it turns into something that literally is the thickness of glue so we start with thin fluid we look at thin fluid we can kind of tell what that looks like thick fluid comes next it’s more like syrup and then finally glue like that old glue when you had an elementary

School you had to squeeze out of the bottle it can get that thick and when we get to the glue it’s not draining down through the eustachian tube it’s just not going to happen so our best chance of draining it on our own through the eustachian tube is when it’s thin the longer it sits there the thicker and thicker it gets now why can’t a child or an adult just

Leave the fluid and maybe it goes away on its own well inside the middle ear we have three hearing bones we call malleus the incus and the stapes those hearing bones were designed to live in an air-filled environment and when the eardrum vibrates from the sound vibrations those hearing bones library in fluid those hearing bones can’t vibrate properly and so you

Get a hearing loss for a small child having months and months of hearing loss from fluid in the ear can affect their speech development it can certainly affect their behavior it can affect their balance development walking in that sort of thing for an adult middle ear fluids just plain annoying they know what a middle ear space is supposed to feel like and they

Find it highly annoying to have their fluid stuff in there here another reason we can’t leave middle ear fluid indefinitely is those bones will resorb over time and so what you tend to see is those bones begin to soften in the fluid typically they’re very rigid and hard but in a environment they soften and now if they’re not rigid they don’t conduct the vibrations

Nearly as well and you begin to get a hearing loss sometimes that loss of bony rigidity becomes permanent in severe cases fluid causes erosion of the bones and that erosion will sometimes even cause the bones to separate and then you get a big conductive hearing loss because the bones are no longer connected and they can’t transmit the vibrations into the inner

Ear that allow us to hear so fluid in the middle ear is a problem the longer it sits there the harder it is for it to drain on its own and the longer it sits there the more risk of continued hearing loss in small children speech problems speech delay and in just about everybody middle ear fluid sitting there can pose a risk of damage absorption or destruction of

The hearing bones i hope that was educational and thank you for listening

Transcribed from video
Middle Ear Fluid By Keith Forwith PhD MD