How does fluid get into the ear?

Whenever we come down with the common cold or get a sinus infection, our nose becomes congested because of the fluid produced by the body in an attempt to deal with the invader. Our body produces a mucous-type discharge in the nose to wash away the pathogen. The lining of the middle ear acts similarly to the nose lining in the sense that when a pathogen causes an infection in the ear canal, it will produce an ear discharge to wash the invaders away. 
If everything goes well, and as the infection clears up, the fluid gets drained out by the eustachian tube into the back of the nose. However, fluid will not drain when the eustachian tube is swollen or does not work correctly; instead, it will get stuck in the middle ear cavity. 

Middle ear infection (otitis media)

In the medical literature, fluid in the middle ear is referred to as serous otitis media. One of the most common reasons for this condition is a middle ear infection. If you have ever had a middle ear infection before, you probably experienced severe ear pain and possibly pus-filled ear fluid. 

In most cases, middle ear infection (otitis media) symptoms develop quickly and resolve in a few days. When the infection is of short duration, it is called acute otitis media. The primary symptoms of this condition are fever, earache, feeling a lack of energy, and mild hearing loss.

In more severe cases, you may experience a ruptured eardrum (tympanic membrane perforation). A perforated eardrum is a hole or a tear in the thin tissue that separates the ear canal from the middle ear. When the hole develops in the eardrum, pus may run out of the ear. 

How do doctors diagnose fluid in the ear?

The best way to diagnose fluid in the ear is to examine the ear using an otoscope. This is a very simple procedure that involves pulling back the ear and inserting the tip of the otoscope into the ear. With the help of the otoscope, the healthcare provider can see the eardrum (tympanic membrane). Unfortunately, it is not easy to see if there is fluid behind the eardrum, and often the only thing indicating fluid in the ear might be a slight retraction of the eardrum or slight discoloration. 

Another test that doctors can use to detect the presence of ear fluid is tympanometry. For this test to work well, you must be still during the exam, refrain from speaking or swallowing if possible. 

Are antibiotics necessary to treat middle ear infections?

If your doctor suspects that bacteria is causing your condition, he might prescribe an antibiotic. Remember that antibiotics should not be prescribed routinely to treat middle ear infections because the overuse of antibiotics can lead to antibiotic resistance. Nonetheless, healthcare providers may occasionally prescribe them if symptoms last longer than a few days or are very severe. 

If your doctor prescribes an antibiotic, be sure to complete the entire course. Some antibiotics need more time to work, and stopping treatment too soon may result in unsuccessful treatment and may also contribute to the development of antibiotic-resistant bacteria. The good news is, the fluid generally drains out once the antibiotic begins to work, and the bacteria die off. Unfortunately, sometimes fluid can remain trapped in the ear canal even after the infection resolves and the pain and discomfort subsides.

Can fluid drain out on its own?

The longer fluid stays trapped in the middle ear, the thicker it becomes over time. While thin fluid may cause only a slight degree of hearing loss or muffling of the hearing, thick fluid can cause moderate hearing loss. Unfortunately, our chances of draining the fluid through the eustachian tube are much better when the fluid is thin. 

However, natural ear drainage becomes virtually impossible as the fluid thickens, leading to the development of "glue ear," which happens when the middle ear becomes filled with a fluid of glue-like consistency. 

What should I do if ear fluid gets trapped in my ear canal?

Improper drainage typically occurs because the eustachian tube becomes swollen and closed. To help remedy the fluid in the ear, your physician will likely recommend various over-the-counter or prescription anti-inflammatory drugs. However, if these medications fail to resolve the problem, surgical fluid drainage may be necessary. 

Your doctor will do this by performing a myringotomy procedure by making a small hole in the eardrum. Although this surgery sounds quite invasive, it can be done on adults in the outpatient setting, i.e., in the office, relatively pain-free with the use of a topical anesthetic. 

Young children, however, usually need to be sedated, and therefore the procedures need to take place in an operating room. 

Why can't middle ear fluid be left alone?

Many people wonder why can't we just leave middle ear fluid alone. The reason is that the three hearing bones (ossicles) inside the middle ear were meant to live in an air-filled environment. When the eardrum vibrates from the sound vibrations, so do the hearing bones. In fluid, the hearing bones cannot vibrate properly, leading to hearing loss. 
In summary, the longer fluid stays in the middle ear, the harder it becomes for the fluid to drain on its own, leading to continued hearing loss. For small children, in particular, experiencing hearing loss for many months can impair speech development, balance, and even behavior. In addition, middle ear fluid sitting in the ear canal can permanently damage the hearing bones. 

What other causes could be behind clogged ears?

Impacted ears
An excessive amount of earwax can make your ears feel clogged. If you think you have impacted ears, you can give over-the-counter drops a try. However, seek medical attention if the earwax is lodged deep in your ear canal and does not come out in a couple of days. Also, steer clear of using a Q-tip to try removing earwax. When you stick an ear swab into your ear, you might push the wax further into the canal.
Eustachian tube dysfunction
The Eustachian tube connects the middle ear to the back of the throat. When this tube does not function as it is supposed to, it will not open and close properly, resulting in a clogged-up feeling. If the Eustachian tube is blocked due to swelling or fluid, it cannot equalize the pressure between the middle ear and the outside atmosphere. 

Experiencing clogged ears on an airplane is a prime example of pressure equalization problems. Respiratory viruses, sinus infections, and even allergies can cause this troubling dysfunction. Clogged-up ears tend to respond to over-the-counter medications because many of them can help reduce fluid accumulation and swelling.
Upper respiratory infections, such as COVID-19 often lead to fluid buildup in the ears. If you suspect that you may have contracted COVID-19, get tested to rule it out. 
Hearing loss
Some people suffering from hearing loss feel like their ears are clogged. If you are experiencing hearing loss without an apparent cause, it is best to get a hearing test done by an experienced audiologist. 

Do not delay seeking help from a hearing care professional because many causes could be at the root of your unexplained hearing loss. Whether it is age-related or noise-induced hearing loss, some type of disorder, it's critical to get a proper diagnosis.

In summary, anytime you experience ear fluid, be sure to seek professional help to get the fluid safely out of your ear.