Glue Ear:

Glue ear (otitis media with effusion) is one of the most common ear problems seen in children by both GPs and ENT specialists alike. To understand it, it helps to know a little about the normal anatomy of the ear:

Going from the outside in, the ear canal (outer ear) ends at the ear drum, behind which is a small space called the middle ear which is normally filled with air. This air-filled space is connected to the back of the nose by a tiny tube (Eustachian tube). Sound hitting the ear drum is transmitted across the middle ear through 3 tiny bones which carry the sound vibrations on into the inner ear where the hearing nerve conveys the sound signal on into the brain.

Glue ear is simply a condition in which the air in the middle ear cavity is replaced by thick, gluey fluid. Most of us, children and adults alike, will collect fluid behind the ear drum after having a cold or ear infection because of an increased secretion of mucus common to these conditions (in a similar manner in which the sinuses can become blocked with mucus or catarrh in sinusitis [see Sinusitis]). Normally this fluid disappears from the middle ear over a week or so by draining down the Eustachian tube into the back of the nose. In children with glue ear, however, this drainage is poor and the mucus accumulates in the middle ear space and becomes increasingly viscous.

The main problem caused by glue ear is a reduction in hearing. Pain is not usually a typical symptom although mild ear ache may occasionally feature. Acute ear infections are, however, more likely to develop in children with glue ear: such infections will typically produce symptoms of ear ache and a general unwellness with high temperature.

Although some children may be aware that their hearing is reduced, often, particularly in younger children, this is not the case and Mums, Dads and particularly teachers may notice a variety of features including poor concentration, a tendency to say "what" or "pardon" frequently and a tendency for the child to sit very close to the television. As the problem of glue ear is often an intermittent one, symptoms can come and go with periods of normal hearing in between times. Indeed most doctors have seen children who have been thought to have behavioural problems but in whom this behaviour was subsequently found merely to reflect their frustration with poor hearing that had not been recognised.

The significance of glue ear is the potential for a child's speech and language development and therefore education to suffer because of the reduction in hearing. During childhood the Eustachian tube grows and widens and the drainage of the middle ear space improves as a consequence, so most children will outgrow the tendency to develop glue ear by about the age of 10 or 11. However, when hearing is significantly affected it is important to act against the problem in the meantime.

When glue ear is suspected, perhaps after a teacher has noticed poor concentration by the child in class, the GP will examine the ears. If glue ear is likely to be the problem and the problem is of recent onset, it may be best to merely review the situation in 6 weeks' time (as the fluid behind the ear drum will often clear by itself as we have seen) whilst taking steps at home and in the class to allow for the reduced hearing, eg, by sitting the child near the front of the class and talking clearly and directly (face-to-face) to the child.

Where the problem persists, referral to a specialist Ear, Nose & Throat Surgeon may be necessary. At the hospital hearing tests are usually performed and a decision can be made on the best course of action depending on the degree of hearing loss, age of the child, duration of the symptoms, etc.

The main specialist treatment for glue ear is an operation in which a grommet is inserted into the ear drum after a small cut is made into the drum and the thick 'glue' sucked out. A grommet is simply a tiny hollow tube which spans the ear drum. This provides, in addition to the Eustachian tube, another opening in the middle ear space which allows fluid to drain away and air to enter thereby reducing the chance of mucus re-accumulating. Grommets bear no resemblance to a canine cartoon character!

Over the coming months, the grommet will fall out of the ear drum and the hole in the drum will heal over. Occasionally, if glue ear recurs, it may be necessary to repeat the operation. In older children it may also be necessary to remove the adenoids as well as inserting grommets, as the adenoid tissue sits at the back of the nose near to the opening of the Eustachian tube where it can interfere with its drainage.

Disclaimer: This page is for informational purposes only and should not be considered as medical advice or substituted for professional advice. Always consult your doctor with your questions and concerns.