Natural Approaches to Fluid in Kids’ Ears (Serous otitis)

Ask Dr. Aviva: Antibiotics for Fluid in the Ears?

The Q: Hi Dr. Aviva <3. I am trying to do the best for my kid and wanted your feedback. She has thick fluid in her ear, and the ENT suggests an antibiotic to break up the fluid proteins, etc… stuff I am not understanding. Her hearing technically is affected, although she is not showing it, and there is no damage, but as long as the fluid is there, she has hearing loss, even if it is for sounds that are really very low… I wonder if you have any herbal and/or homeopathic suggestions for me to read up and look into? I am a big follower of your FB posts and I thank you so much for the awesome work you do <3

Dr. A: Hi Lovely Mama! Thank you for writing. Yes, you are asking a great question and brava in questioning whether every antibiotic prescription is necessary for your kiddo! I bet a lot of parents have this question, too.

Here's the medical bottom line: While antibiotics are generally not considered necessary for what is called otitis with effusion – or fluid in the ear without signs of infection – or even for most actual ear infections, for that matter, pediatric medicine considers it reasonable and appropriate to try an antibiotic for long-term fluid (weeks to months of it) that isn't otherwise resolving. So it's an option to consider.

In my practice, I generally try natural remedies first for a few weeks to avoid unnecessary antibiotic use when I can, because there are risks of side-effects with any medication.

Natural Remedies for Otitis with Effusion (Fluid in the Ears without Infection)

My big go-to for otitis with effusion is a supplement called NAC, or n-acetylcysteine. There is very good data on its safety and effectiveness for exactly this purpose in children and adults. A typical dose is anywhere from 300 mg to 900 mg, daily, depending on the child's age, and up to three times daily may be needed and is considered safe. NAC is available in health food stores, and online, and may take several weeks to work. You can open the capsules for young kids and put the powder into some applesauce.

Quercetin and freeze-dried stinging nettles are also powerful for clearing up fluid in the ears. They are natural antihistamines from food and herbal sources that don't overly dry you out, or cause side effects like drowsiness.

Classic herbs include eyebright and plantain, which can be given in tincture forms, and can be used in conjunction with NAC. I also recommend my Kids' Fire Cider recipe, which is in my children's herbal course, and which I am sharing here, too! It's great for opening up the ear and sinus passages, but is too strong for kids under 3 years old.

Consider doing an herbal steam each day for 3-5 days to help loosen the congestion in the ear canals. To do one: turn the shower on full heat, toss a washcloth with a few drops of oregano, thyme, or peppermint essential oil on a washcloth under the running water and close the bathroom door so steam builds up for about 5 minutes. Then take your child into the bathroom (not into the shower) to inhale the steam for 5-10 minutes.

Look for the Root Causes

Whenever there is fluid in the ears, I also want to consider underlying causes. Allergies are the most common – something in the environment or foods. I usually recommend a couple of weeks removing juice, dairy, and sometimes gluten-containing products. Often just removing juice and dairy helps tremendously. For more on allergies in kids and additional supplements, and also on otitis media with effusion, my online kids' courses, Healthy All Year, and The Allergy Epidemic are a high value – chock full of info on these topics, and pretty affordable – if you want to take a deeper dive. Here's the link (and hint: major sale coming next week on Healthy All Year which has even more information on otitis).

Kid Friendly Fire Cider

Ok. This stuff is no joke – it’s got a punch. And it takes only about 10 minutes to prepare, but 1-2 weeks to “mature,” so make it ahead of time. In our house, “putting up remedies” is something I typically do in the spring and fall, natural herb harvest times. But you can put up some Fire Cider any time you get the itch to make some. I’ve modified this recipe to take out some of the sting and bite. But we all know those kids who like spicy foods and foods that pack a flavor punch. My granddaughter's favorite first food was “spicy pad thai.” Go figure!

Have fun with this – once you make your own first batch, you’ll see how easy it is and you can play with your own recipes and even have your kiddos make up their own faves! Download the PDF of my recipe.

Most of us pay tribute to herbalist Rosemary Gladstar for popularizing Fire Cider. There are now as many recipes as there are herbalists and crafty mommas!


  • 1/4 cup peeled and shredded/diced ginger root
  • ¼ cup peeled and shredded/diced horseradish root
  • 2 TBS diced fresh turmeric (if you can get it)
  • 1/2 cup white onion, chopped
  • 2 TBS minced fresh garlic
  • 2 cinnamon sticks
  • Zest and juice from 2 organic lemons
  • Raw apple cider vinegar
  • Raw, organic honey to taste

Pack all of the herbal ingredients into a 1-pint mason jar. Cover the herbs plus 2 inches over with apple cider vinegar and lemon juice. The important thing is to keep the ingredients immersed in the liquid, so you might need to “top if off” once every few days over the 2 weeks it’s “working.”

Place in a dark cabinet away from heat for 2 weeks. At the end of the 2 weeks, strain the whole thing thoroughly, and mix in ½ to 1 cup of good quality honey. Put into a clean jar and store in the fridge. It will keep for months.

Dose: This is for kids 3 and over because it packs a spicy punch. Give 1/2-2 tsp depending on age. Kids can take it right off the spoon or mixed in 1/4 cup of water (or if need be, fresh juice) . It’s an acquired taste and not all kids will go for it. But it’s a great preventative and will knock out the start of a cold in no time flat!

For more information on courses in Healthiest Kids University, and what you can do to get, and keep your kids healthy and Pharma-Free all year, head on over here.

American Academy of Family Physicians, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics Subcommittee on Otitis Media with Effusion. Otitis media with effusion. Pediatrics 2004;113(5):1412-29.

Pintucci JP, Corno S, Garotta M. Biofilms and infections of the upper respiratory tract. Eur Rev Med Pharmacol Sci. 2010 Aug;14(8):683-90.

Centers for Disease Control and Prevention. Otitis Media: Physician Information Sheet (Pediatrics)

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Biliana Coleman

Thank you so much for your help!!!!!! I will absolutely follow your advice and will get back to you with my feedback. We love you <3 Biliana

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Hi Aviva, great info and very relevant to our situation right now. My daughter has chronic ear infections and congestion (shes 19 mo now, had since she was 2 wks). We are testing for allergies and also saw the ENT today who scoped her and said her esophagus is red due to reflux (which was not a surprise). He said all of these symptoms are probably due to the reflux including the fluid in the ears. So my question is, if the ear fluid is tied to something like this, does it make sense to treat in this way, or just treat the root cause, once its confirmed? Seems like we are seeing ENT, allergist, etc and its all tied together but the Dr;s don't communicate so its frustrating, but that's for another day. :) Thanks!

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Is it alright to mix the fire cider in kombucha?

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    I would think so...Haven't tried it! I don't give kombucha to kids ,though. It's not a lactofermented beverage, so is yeast based, with a decently high sugar content, to my knowledge.

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Christina Walsh

Where can I find more information about using NAC for children? Do you recommend a brand that sells NAC?

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    Aviva Romm

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Karin Fink

Dear Aviva, thank you for this relevant information. I was wondering if you had any opinion on the usage of infrared light to relieve the effusion?

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    Aviva Romm

    Hi Karin, I've never heard of this! So no opinion at this time on it....