Middle Ear Effusion

Middle Ear Effusion


A college student has had congestion, runny nose, and a cough for several days. She then developed ear pain. She was tested for COVID and found to be negative. This image was obtained. Would you initiate antibiotics? Which ear is this?

The student has a middle ear effusion, antibiotics are not indicated. It is the left ear.

This is a common clinical scenario. Ear pain following several days of viral symptoms. The key to diagnosing a middle ear effusion is the presence of fluid and air-fluid levels behind the tympanic membrane. In addition, in an MEE the eardrum is not bulging as in acute otitis media (AOM). The presence of air-fluid levels indicates the Eustachian tube is functioning correctly, ventilating the “other side” of the tympanic membrane, or the middle ear space.

You can tell this is the left ear as the malleus bone always points towards the face.

Here is another example of a middle ear effusion.

See the video of the complete exam of the left ear:

Complete exam video


WiscMed thanks Anna Grasee of the University of Minnesota for this interesting case.