What is fluid in the ear?
The middle ear is an air-filled space behind the eardrum, connected to the back of the nose by the Eustachian tube. Normally the tube opens when you swallow or yawn to equalise pressure and drain fluid. If the tube is blocked or swollen, air is absorbed, negative pressure develops and fluid collects (effusion). The fluid may be thin and watery or thick and sticky (glue ear). It may or may not be infected. See Eustachian tube dysfunction.
Symptoms in adults
- Muffled or reduced hearing, often like hearing underwater.
- A feeling of fullness or blockage in the ear.
- Popping, crackling or gurgling sounds, especially when swallowing or yawning. See crackling in ear.
- Mild ear discomfort rather than severe pain.
- Tinnitus or a sense of imbalance in some people.
- Your own voice sounding louder in the affected ear (autophony).
- Often follows a cold, flight or allergy flare.
Symptoms in children (glue ear)
- Not responding when called or asking “what?” often.
- Turning the television up.
- Delayed or unclear speech. See late talker.
- Inattention at school or in class and behaviour changes.
- Tugging at the ears and disturbed sleep.
- Balance problems or clumsiness.
- Recurrent ear infections.
- Glue ear is most common between ages 2 and 5, affecting many children at some point.
Causes
- Colds and upper respiratory infections causing tube swelling.
- Allergies and chronic rhinitis/sinusitis. See stuffy nose and sinus infection remedies.
- Enlarged adenoids in children, blocking the tube opening.
- Ear infection (otitis media), where fluid remains afterwards.
- Pressure changes from flying, diving or altitude.
- Smoke exposure and reflux.
- Cleft palate and Down syndrome in children.
- In adults, rarely, a mass in the nasopharynx can block the tube.
How long does it last?
After a cold or infection, fluid commonly lasts a few weeks. About 90% of cases resolve within 3 months without treatment. Fluid that persists beyond 3 months, causes hearing loss or recurs repeatedly needs an assessment by an ENT or audiologist. In adults, symptoms on only one side lasting more than 4–6 weeks without a clear cause warrant examination of the nose and throat.
What you can do at home
- Treat congestion and allergies: saline rinse, steroid nasal spray or antihistamine as advised. See neti pot sinus rinse.
- Chew gum or swallow and yawn to open the Eustachian tubes.
- Try gentle autoinflation: pinch the nose, close the mouth and gently blow out (adults); in children use a balloon autoinflation device, if advised.
- Avoid smoking and smoke exposure.
- Avoid flying or diving while blocked if possible.
- Do not use cotton buds or insert anything in the ear.
- Use pain relief if there is discomfort.
- Do not use decongestant nasal sprays for more than 3 days.
Medical treatment
- Watchful waiting for about 3 months, with hearing tests, because most cases resolve.
- Treatment of underlying allergy or sinus disease.
- Antibiotics only if there is acute infection.
- Grommets (ventilation tubes): small tubes placed in the eardrum under anaesthetic for persistent fluid with hearing loss, repeated infections or speech and school problems; adenoidectomy may be added in children.
- Hearing aids as a temporary option when surgery is not suitable.
- Adults: a camera examination of the nose and nasopharynx, particularly for persistent one-sided fluid.
- Steroid or antihistamine tablets are not recommended for glue ear in children.
Hearing tests
A hearing test (audiogram or tympanometry) shows whether fluid is reducing hearing and how much. Conductive hearing loss from fluid is typically mild to moderate and temporary. In children, it can affect language learning and school performance if prolonged, which is why persistent fluid with hearing loss needs follow-up. See clogged ears.
Flying and diving with fluid in the ear
Changes in pressure can be painful when the Eustachian tube is blocked. If you must fly, use a decongestant nasal spray shortly before descent (if suitable for you), chew gum or swallow, and try gentle autoinflation. Avoid diving until the problem has resolved. For children, offer a drink or feed during take-off and landing.
When to see a doctor
- Fluid or fullness lasting more than 3–4 weeks, or one-sided in an adult.
- A child with possible hearing loss, speech delay or school difficulties.
- Severe pain, fever, swelling behind the ear or discharge.
- Dizziness, facial weakness or sudden hearing loss: urgent.
- Recurrent ear infections.
- Smoking history with unilateral fluid.
Three common situations
An adult with a blocked ear for 10 days after a cold: allergy treatment, nasal rinses and time usually clear it.
A 4-year-old with muffled hearing and unclear speech: hearing test and ENT follow-up for glue ear.
A smoker with fluid in one ear for 8 weeks: needs examination of the nose and throat promptly.
Key points to remember
Fluid in the ear usually follows a cold or allergy and clears on its own, but persistent fluid, hearing loss or one-sided fluid in adults needs checking. Treat the cause and, if needed, consider hearing tests and grommets. Our ENT team can examine your ears and hearing.
This guide is for general information and does not replace an examination by your own doctor or ENT specialist.
Questions about fluid in the ear
These answers are general information and do not replace an examination or individual medical advice.
What causes fluid in the ear?
A blocked Eustachian tube from a cold, allergy, sinus problems or enlarged adenoids.
How long does fluid in the ear last?
Often a few weeks; most cases clear within 3 months.
Is fluid in the ear an infection?
Not always; it may be sterile fluid or may follow an infection.
Does fluid in the ear hurt?
It usually causes fullness and muffled hearing rather than severe pain.
Do I need ear tubes?
Only if fluid persists with hearing loss, repeated infections or developmental concerns.
When is fluid in one ear serious in adults?
If it lasts more than a few weeks, particularly in smokers, it needs examination of the nose and throat.
Sources
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.