Glue ear is the commonest cause of childhood hearing loss. The middle ear space behind the tympanic membrane (ear drum) fills with a glue-like fluid instead of air, which causes a conductive-type hearing loss. This varies in severity. The resultant hearing loss is similar to that which would be experienced after a cold, or if you were to put your fingers in your ears.
Who gets glue ear?
This is predominantly a condition of childhood with peaks at ages 2yrs and 5yrs. It is estimated that 90% of all children in England will have at least one episode of glue ear by the time they are 10yrs of age. The incidence is highest in the winter months. While it is not known exactly what the causes of glue ear are, a number of risk factors have been identified and these include:
Why is glue ear a problem?
The main problem is that the hearing is impaired. This can lead to frustration and behavioural problems if prolonged and untreated, and a failure for the child to realise their true academic and social potential. It can also cause recurrent ear infections with febrile illness, severe pain, subsequent tympanic membrane rupture and discharge.
How is it diagnosed?
When fluid is present behind the tympanic membrane, it will have a particular appearance which will be obvious on otoscopic examination by your General Practitioner. Additional specialist tests may be necessary to assess the impact on your child's hearing and these include playaudiometry, tympanometry and a pure tone audiogram.
What treatment is required?
It is important to remember that children who have had a recent upper respiratory tract infection will show glue ear, and therefore 50% cases of glue ear will resolve within three months without any treatment. A period of watchful waiting of three months is, therefore, advised. Antibiotics, antihistamines, decongestants and nasal sprays have been used in the past, but there is not good evidence to prove their efficacy.
During the period of observation, I sometimes advise parents to encourage their children to use a Nasovent device, which is a balloon with a particular compliance which the child blows up, helping to open the Eustachian tube.
If the glue ear persists and is associated with a significant hearing loss or recurrent ear infections, grommet insertion may be necessary. This is a small, plastic tube which is inserted into a small incision(cut) in the ear drum, which allows middle ear pressure to equalise, even if the Eustachian tube is not functioning normally. This is inserted under a general anaesthetic on a day case basis and usually results in an immediate restoration of hearing. The grommet generally extrudes naturally between six and eighteen months, by which stage most children will have outgrown the tendency to glue ear, but unfortunately up to 30% of children may require a second grommet.
What precautions are necessary once a grommet has been inserted?
Although it is possible for your child to swim with their head under the water in the sea or swimming pool, they should not dive too deep. Because detergent is used in the bath or shower and this lowers the surface tension, it will be necessary to use ear plugs during these activities.
Are there any alternatives to grommet insertion?
As already stated, if the hearing loss is not significant or the glue ear is only short-lived, no treatment will be necessary. However, where it persists, the only alternative treatment would be the use of a hearing aid, but this obviously would not help in the case of recurrent infections.