Fluid Behind the Ears

Ear infections occur in a space behind the eardrum called the middle ear. The Eustachian tube connects your middle ear and the back of your nose. Ear infections occur because the kids get full of snot, that tube that connects the middle ear space and the back of the throat/nose gets clogged and then we get a middle ear space filled with pus.

We don't treat any other pus filled spaces with antibiotics. We lance boils, pop zits, drain abscesses... so when kids get ear infections, I should be lancing the pus. Yup, sticking a needle across the eardrum and getting the pus out of there, right in the office. Hah! Never going to learn how, although there are plenty of docs that do that.

The reason we drain pus is that antibiotics work through the bloodstream and there isn't much blood that goes to the pus. Antibiotics probably help with clearing the snot, but probably don't help much with the infection, It's one of the reasons that the Europeans don't treat ear infections with antibiotics.

So, we have pus behind the drum and really no way to treat it, except antibiotics that maybe get in there, maybe not.

We prescribe antibiotics for 10 days, which is probably way too long and then see you back in a month to make sure everything looks better. I would change an antibiotic if the boogers didn't get better, the fever never went away or the child stayed crabby.

What's left behind when you don't lance a boil is something called an effusion. We tell you it's "fluid behind the ears." That effusion doesn't contain bacteria, can be really, really annoying to the kids (so they'll probably still pull at their ears like we would if we were on an airplane and couldn't pop our ears) and does not get better with antibiotics. One of the things I hear a lot is "this is his 5th ear infection in the last 4 weeks and we've tried 3 different antibiotics and nothing works." That scenario is more likely one infection and an effusion and those extra courses of antibiotics are unnecessary unless new symptoms develop.

The effusion can be present for up to 3 months or more and we can give antibiotic after antibiotic and it won't make a difference. The antibiotic won't help an asymptomatic effusion. If your child takes the antibiotics and then gets snotty again, a new fever develops or they are newly crabby, then maybe it's an new infection that needs antibiotics, otherwise it's an annoying effusion.

We should be seeing you back, if your child is happy, less snotty and has no fever, in about a month after the infection was diagnosed, since the effusion that's left over behind the eardrum (because I didn't lance the drum) lasts for months in some kids. If it goes on for 3 months, then I send you to my favorite ear, nose and throat doc, and they, under the humane condition of general anesthesia and with much more skill than I will ever have, puts in tubes to drain the effusion.

Sometimes the eardrum ruptures. That's cool... Mother Nature doing what I was too chicken to do. In that case, clean the pus as it comes out and make a recheck appointment in one month. The drum usually heals up without a problem and your child usually feels bunches better.