This factsheet is part of our Ears and ear problems range. It is mainly for parents of children who have glue ear.
- What is glue ear?
- What are the symptoms of glue ear?
- How does a child get glue ear?
- What causes glue ear?
- What happens if glue ear is left untreated?
- What should I do if I think my child has glue ear?
- What will happen if we have to see an ENT consultant?
- What are grommets?
- What about other treatments?
- How can I help my child?
- Where can I get further information?
Glue ear is the build-up of a sticky glue-like fluid in the middle ear as a result of chronic inflammation. A healthy middle ear (the space immediately behind your eardrum) contains air and no fluid. This helps the eardrum to vibrate freely in response to sound. Glue ear can cause temporary deafness.
Glue ear is a very common condition in young children aged between two and five years. In most children, glue ear clears up on its own. However, up to 5% of children get persistent glue ear. If left untreated, this can cause permanent hearing loss. Doctors call inflammation of the middle ear ‘otitis media’ and if it results in glue ear, they call this ‘otitis media with effusion’.
What are the symptoms of glue ear?
The symptoms of glue ear are not always very obvious. Glue ear can affect a child’s hearing, although the hearing loss may not be present all the time and may fluctuate. This can sometimes make it difficult to know if your child is having hearing problems. If their hearing is affected, a child may sometimes not respond when talked to, may find it difficult to concentrate, and quickly get tired and irritable. Young children may be slow to develop speech. Older children may be able to tell you if they cannot hear very well. You may notice that they say ‘pardon?’ or ‘what?’ a lot, or that they turn the television up loud.
How does a child get glue ear?
To understand how a child gets glue ear and how it affects hearing, first, we need to explain a bit about how the ear and hearing system works.
Sound waves enter the ear and move along the ear canal until they reach the eardrum, causing it to vibrate. A chain of three small bones (ossicles) in the middle ear link the eardrum to the inner ear. These bones transmit the vibrations from the eardrum to the cochlea in the inner ear, where there are thousands of tiny sound receptors. From here, the ‘sound message’ is passed along the nerve of hearing to the brain.
The middle ear needs to be full of air to let the eardrum and small bones vibrate freely. Air reaches the middle ear through the eustachian tube, which connects the middle ear to the back of the nose and throat. The eustachian tube is closed for 95% of the time and only opens when you swallow or yawn. If the eustachian tube can’t open properly, you get a vacuum in the middle ear.
Children have a smaller, more horizontal eustachian tube than adults do. This makes it more likely to become blocked, which stops it from opening properly. This can lead to a vacuum in their middle ear. Once this vacuum has formed, the lining of the middle ear becomes inflamed. To begin with, a thin fluid seeps out from this lining into the middle ear space. This is what happens if your child has an ear infection or if the eustachian tube is blocked for other reasons. The fluid can then become thicker, causing ‘glue ear’. Fluid in the middle ear especially if it thickens, can prevent the eardrum and small bones from vibrating which affects hearing.
What causes glue ear?
Glue ear is more common in winter and more common in boys than girls. Many children can get glue ear because of:
- a cold
- an ear infection
- allergies to pets, pollen or dust.
Passive smoking may also cause glue ear in some children. Some children with palate problems, such as a cleft palate, can keep getting glue ear.
What happens if glue ear is untreated?
Glue ear usually goes away by the age of seven or eight and the condition improves on its own before adolescence in 95% of children. When the glue ear does not clear up and is not treated, it can result in permanent hearing loss. This is because over a long period it may cause permanent changes to the eardrum.
What should I do if I think my child has glue ear?
If you are worried about your child’s hearing and think they may have glue ear, you need to take your child to see your GP. At the first visit, your GP will:
- examine your child’s ears for signs of glue ear
- ask questions to find out if your child’s hearing has been affected
- assess your child’s hearing indirectly, because few doctors’ practices have the equipment and staff to carry out proper hearing tests.
The treatment your GP offers for glue ear will depend on:
- how long and how often your child has had glue ear
- the severity of the problem
- how much your child’s language and development are being affected.
Your GP may prescribe antibiotics if they notice an infection or if your child has pain. Some GPs prescribe oral decongestants (tablets) to thin the fluid in the ear and help it drain away, but there is no convincing evidence that these help. Some GPs prescribe antihistamines or nasal steroids in the form of drops or sprays for children with allergies.
As most children recover naturally from glue ears, GPs usually adopt a wait-and-see approach to begin with. Your child will normally be observed for about three months to see if they need treatment. If your child continues to have problems, your GP may decide to refer them to an ear, nose, and throat (ENT) consultant at a hospital or clinic near you.
What will happen if we have to see an ENT consultant?
The ENT consultant will examine your child’s ears and treat the symptoms of glue ear. Your child will also be seen by an audiologist who will carry out hearing tests and tympanometry.
Hearing tests will help the audiologist find out your child’s level of hearing and how well their middle ear is working. Your child will be played different sounds via headphones, through a small vibrating pad on their head or through loudspeakers and the audiologist will make a note of which sounds your child responds to. These tests do not cause any discomfort and children usually find them interesting.
Tympanometry tests the eardrum to find out if it is moving normally and also tests how well the middle ear is working. It can be carried out on all children, including babies. It should not be painful and takes less than a minute for each ear. A graph called a tympanogram will show the results immediately.
What are grommets?
If your child has had glue ear over a few months and hearing tests have shown that this is causing hearing loss, they may need a ‘grommet’ or ventilation tube. This involves making a small hole in the eardrum, removing the fluid, and inserting the grommet through the hole. The grommet keeps the hole open for a few months, lets air into the middle ear space, and lets fluid in the middle ear drain away. Your child’s hearing should then return to how it was before they had glue ear. This procedure is known as a myringotomy and grommet insertion. It is carried out under a short general anesthetic and takes about 15 minutes. Your child will usually be allowed to go home the same day.
What happens to the grommet?
The grommet slowly moves outwards as the eardrum heals. It is then naturally pushed out of the eardrum into the outer part of the ear. It moves outwards with ear wax until it falls out of the ear canal, often unnoticed.
Most grommets fall out nine to 15 months after insertion. If the grommet becomes loose in the ear canal they can easily be removed at an ENT clinic. Over half of the children who have grommets do not need further surgical treatment as they get older. However, 30% of children will need grommets inserted a number of times until their glue ear improves. Although the eardrum is tough, repeated grommet insertions may eventually scar it, which can sometimes cause mild permanent hearing loss.
Looking after a child with grommets.
The hole in the eardrum for grommet insertion is small. However, it is worth taking a few simple precautions to stop water from getting into your child’s ear:
Your child should swim on the surface of the water only – and not dive.
Ear plugs will protect the ears while showering and swimming. You can also buy waterproof plugs from chemists and most audiology departments will custom-make them for children.
Flying is actually easier for a child with a grommet in their ear. The grommet allows air in and out of the ear and reduces the stress on the eardrum that is caused by changes in air pressure in the aircraft. However, children who have a history of frequent ear infections or who have had grommets in the past (but no longer have them) are occasionally at risk of perforation of the eardrum when flying. If you are worried about this, ask your GP.
About 5% of children with grommets get an ear discharge at some time, often after a cold. This is usually not serious or painful, but it is important to keep your child’s ears clean and to consult your GP as soon as possible. Your GP will usually prescribe antibiotics or eardrops.
If your child gets a lot of discharge, gently clean their ears using clean cotton wool or a very soft cloth. Never use a cotton bud as you may go too far into the ear and cause damage. For most children, if infections are treated quickly, the ears will get back to normal with the grommets in place.
What about other treatments?
Other surgical treatment for glue ear involves an ‘adenoidectomy’. This involves taking out your child’s adenoids, which are tissues (similar to tonsils) at the back of the nose. This might be recommended if it is thought that the adenoids are enlarged and contributing to your child’s glue ear. An adenoidectomy is commonly carried out in children over the age of three and is thought to help stop your child getting glue ear again.
Removing their adenoids does not harm your child. Adenoids are removed through the mouth under general anaesthetic. Your child is usually allowed to go home the same day.
NON SURGICAL TREATMENTS
Autoinflation and the otovent treatment
Glue ear causes fluid to build up in the middle ear. Autoinflation is a method that can be used to encourage the eustachian tube (which runs from the middle ear to the back of the nose and throat) to open, which helps drain the fluid from the middle ear naturally. Autoinflation is done by holding your child’s nose and getting them to swallow at the same time. You may need to repeat this. This treatment can be helpful for older children during the ‘wait and see’ period or while they are waiting for grommets or hearing aids.
An otovent is a device made up of a balloon and a nosepiece. It helps glue ear in a similar way to auto inflation. The nosepiece is held against one nostril and your child inflates the balloon using their nose. The act of blowing up the balloon helps to open up the eustachian tube, making it easier for fluid to drain from the middle ear. Your child will need to use an otovent on a regular basis until the fluid has drained.
How can I help my child?
If your child has glue ear, you can do a number of things to help:
- Make sure your child has been properly assessed by your GP who may refer you to an ENT consultant.
- f you think an allergy is causing glue ear, tell the ENT consultant.
- Avoid smoking near your child.
- If they are at school, talk to the teachers if you think their hearing is affected. The school needs to know so that they can make sure your child doesn’t miss out.
Glue ear usually stops being a problem well before adolescence. But you should bear in mind that while waiting to see if glue ear clears up on its own or waiting for grommet surgery, children sometimes have reduced hearing for quite some time and will need help with communication. They may need to use hearing aids and have support at home and school. Here are some ways in which you can make communication easier with your child:
- Reduce background noise when talking to your child, for example, by turning down the television.
- Attract their attention before you start speaking to them.
- Face them all the time you are talking.
- Put your head at their level.
- Do not shout.
- Speak clearly, but do not exaggerate mouth movements.
- Let family and teachers know about the problem.