The most common symptom of glue ear is poor hearing. It sometimes follows a middle ear infection (acute otitis media), although it may occur spontaneously. It is common in childhood, with four out of five children developing it at some stage. It is most prevalent in children aged between 6 to 11 months. The incidence gradually decreases, until at age 11, only 1% of children will suffer from glue ear. In most cases, it will resolve itself without treatment.
What causes glue ear?
The area known as the middle ear is an air-containing space on the inside of the ear drum. It contains the small bones of hearing (the ossicles). Air is puffed into the middle ear through the Eustachian tube, which runs from the middle ear to the back of the nose.
If the Eustachian tube isn’t working properly, then as the air in the middle ear is absorbed by the lining (which happens continuously), a vacuum forms in the middle ear. Cells in the lining of the middle ear then proceed to produce mucus. In this environment, the ossicles are unable to transmit sound properly, and hearing is impaired.
What are the symptoms of glue ear?
Glue ear often occurs in autumn and winter. As it most commonly affects young children, it is often parents and teachers who become aware that a child’s hearing has deteriorated. In persistent cases, this can be accompanied by developmental problems such as speech delay. Parents and carers may also notice a deterioration in behaviour. The child may have trouble concentrating, and may be more tired and frustrated than usual. Occasionally, a child’s sense of balance may be affected, and they may seem unusually clumsy.
An ENT surgeon, such as Mr Julian Hamann, will diagnose glue ear by taking a clinical history, and by examining the ear. Pressure tests can help confirm the diagnosis and hearing tests will assess the level of hearing loss.
How is glue ear treated?
Often, glue ear requires no treatment as it resolves with time. However, in cases of prolonged or recurrent glue ear, treatment options include:
Autoinflation devices: these can be used in mild cases of glue ear. A device, such as the Otovent balloon, can be used to encourage the child to push air through the Eustachian tube and ‘pop their ears’.
Grommets: Grommets are small plastic tubes, inserted under a short general anaesthetic, that bypass the Eustachian tube. They are placed through the eardrum, and stay in place for about six months to a year. The fluid is also drained from the middle ear during the procedure.
Adenoidectomy: the adenoids are sometimes involved in the development of glue ear. They may be removed in persistent cases, or where other symptoms, such as snoring, indicate that this would be beneficial.
How is glue ear prevented?
There are some things that you can do to minimize the risk of glue ear in your child, (although they may not always be practical measures!):
avoid exposure to tobacco smoke. It is thought that the smoke from tobacco may cause irritation and inflammation of the Eustachian tube, increasing the risk of glue ear.
breast feeding for more than six months reduces the likelihood of glue ear.
studies in California and Finland found that children immunized with the pneumococcal vaccination were significantly less likely to need grommets.
the use of dummies (pacifiers) has been found to increase middle ear infections, so could be implicated in glue ear.
bottle feeding whilst your child is in a horizontal position may increase the risk of the Eustachian tube becoming blocked
children in daycare settings are more at risk of glue ear. This may be because they are more exposed to upper respiratory tract infections, which in turn increase the likelihood of glue ear. However, this added risk needs to balanced against the benefits of daycare.
Children with other congenital problems such as cleft palate and Down’s syndrome are also at greater risk of developing glue ear.