When a child has acute otitis media or an ear infection, they have fluid and germs in their middle ear, behind the eardrum. Middle ear fluid is also called an effusion, which is typically cloudy and full of bacteria and white blood cells in the worst part of the ear infection. We call this a purulent effusion, commonly known as pus. As the ear infection goes away the effusion is absorbed by the body or drains through the eustachian tube, a connection in the skull between the ear and back of the nose. This process can take several weeks, but within three months about 90 percent of children no longer have middle ear fluid. So, it would be perfectly normal for a child to have an effusion when an ear infection is first diagnosed but they may not have a persistent effusion when they are examined days or weeks later.

For most children, if their effusions completely clear up between their last infection and the time they are seen in a surgeon’s office, it means that their eustachian tubes work well. Even if these children meet the definition of having had frequent ear infections (three or more in the past six months, or four in the past 12 months), we know from research studies that nearly half will not have more ear infections and only about one in three will continue to have frequent infections.

Other research shows that two out of every three children who see an otolaryngologist for repeated ear infections, but who have a normal examination (no middle ear fluid) in the office, do not require ear tubes in the future. If your child, however, continues to have frequent ear infections, they should be reevaluated by the otolaryngologist and may qualify for ear tubes in the future.