PITTSBURGH -- “I don’t see any cheese in there.”

Jessica Lee, 7, giggles at what her doctor says he does not see in her ear.

But she does have fluid her middle ear. In fact her middle ear fluid has been around off and on for 3 year now.

Back then, Jessica battled repeated bouts of fluid on the ear. Her mom Jennifer was worried about hearing loss and speech delays. Jessica had surgery to place tubes in both ears to drain the fluid. But they didn’t work.

Her mom Jennifer says, “The tubes were obstructed, one after a month, one after 3-4 months. There was still fluid.”

In the end, the tubes were unnecessary.

A half a million children each year get tubes to help drain fluid from the middle ear that won’t go away. Now, three major medical organizations, including the American Academy of Pediatrics, have created this important set of recommendations. It identifies that fluid on the ear is very different from an ear infection.

Dr. Richard Rosenfeld, of Long Island College Hospital was co-chair on the committee that created the recommendations.

He says, “Ear fluid almost never requires antibiotics but ear infections often do. The fluid generally goes away on its own. It’s nothing to worry about. If we went to a preschool on any given day and took 100 children and checked them for ear fluid we’d probably find that 20-30 out of 100 would have ear fluid.”

The committee recommends that for children who are not at risk for speech, language, or learning problems, parents and doctors can simply watch the child for three to six months without putting in tubes.

“What’s not common is to have very persistent or prolonged ear fluid that then requires medical attention,” advises Rosenfeld. If the fluid lasts longer than three months, or if there is evidence of speech delay or behavior problems, hearing should be tested.

The recommendations also say that if surgery is performed, ear tubes are the first option, but removing the adenoids, which is often done, should not be performed unless there is a specific reason to do so. The recommendations also say simple medications like over the counter antihistamines and decongestants are not advised, because they don’t work for this condition.

Really, the authors of the guidelines say in many cases the fluid will take care of itself.

Jennifer decided to hold off on replacing Jessica’s obstructed tubes because she didn’t want to put her daughter through another operation. In the long run, it was the right decision.

“It’s a last resort. If there’s anything I can do I would try that first before I go for another surgery,” says Lee.