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Glue ear

Glue ear (otitis media with effusion) is a condition where there is a build-up of fluid in the middle ear. This can affect hearing.

Glue ear is very common in children – eight out of 10 have had the condition at least once by the time they are 10. Adults can also get glue ear but it's far more common in children.

Glue ear happens when mucus collects in the middle ear. This is often after a middle ear infection (acute otitis media) or similar conditions that cause inflammation in this area.

If the Eustachian tube is blocked, it can stop air from getting into the middle ear. The air that's trapped in the middle ear is absorbed, which reduces the pressure inside the ear and pulls the eardrum inwards. A sticky fluid builds up inside the middle ear and can affect children’s hearing, since the middle ear is filled with liquid rather than air.

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How glue ear develops
Glue ear is a condition where there is a build-up of fluid in the middle ear

Details

  • The middle ear The middle ear

    The middle ear is the space behind your eardrum. It contains three tiny bones that move when sounds reach them. These transmit sound waves through your middle ear to your inner ear. Usually, your middle ear is filled with air, but if you have inflammation, the space becomes filled with mucus.

    The Eustachian tube connects your middle ear with your nose and throat and opens when you swallow. This allows air to pass up and down the tube from your throat to your middle ear and in the opposite direction. This keeps the air pressure inside your ear the same as the air pressure outside. It also means that mucus can be cleared from your middle ear to your nose and throat. However, if it’s inflamed, the Eustachian tube doesn’t open properly and so mucus stays in the middle ear.

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  • Symptoms Symptoms of glue ear

    If your child has glue ear, he or she won't necessarily complain of any symptoms. However, their ear may feel bunged up and their hearing may be poor. This can be mild at first so your child might not notice it happening.

    Because they can’t hear properly, your child may have problems paying attention or interacting with others. It can also interfere with their speech, language and progress at school. Your child may also appear clumsy and have trouble with balance.

  • Diagnosis Diagnosis of glue ear

    Your GP will ask about your child's symptoms and examine them. He or she may also ask about your child's medical history.

    Your GP will use an instrument called an otoscope to look at your child's eardrum.

    Your GP may monitor your child over six to 12 weeks. This is to see if glue ear gets better, or if your child's hearing and language are affected. Your GP may refer your child to a specialist to have a hearing test.

    Your GP may also refer your child to an ear, nose and throat (ENT) specialist if:

    • their condition hasn’t improved after three months of monitoring
    • there is a persistent foul-smelling discharge from their ear
    • your child has severe hearing loss
    • their hearing loss is affecting their learning and development
    • your child has Down's syndrome or a cleft palate

    For more information about hearing tests for glue ear, see our frequently asked questions.

  • Treatment Treatment of glue ear

    At least half of children with glue ear get better without any treatment within three months. Around 95 out of 100 children get better within a year. Only a small number of children have persistent problems that need treatment.

    Non-surgical treatments

    Antibiotics, antihistamines and decongestants aren't recommended for glue ear. There is also no evidence that complementary therapies such as homeopathy, osteopathy, acupuncture, ear candles or special diets help with glue ear.

    Your doctor may suggest your child wears a hearing aid if their glue ear doesn’t clear up and is affecting their hearing. This may be as an alternative to surgery.

    There is some evidence that a technique called autoinflation may help. Autoinflation involves your child using their nose to inflate a special balloon. This increases pressure in their nose and may help to open up their Eustachian tube. This aims to let air into their middle ear so the fluid there can drain out. Some studies have shown this technique to be helpful in the short term, but more research is needed to determine the long-term effects. Ask your GP for more information.

    Surgery

    If your child's condition hasn't improved after three months, your doctor may suggest surgery. Surgery is also recommended for children who have severe hearing loss. However, it’s worth bearing in mind that nearly all children who have glue ear get better within a year without treatment.

    Surgery may involve a procedure called a myringotomy. In this operation, the surgeon will make a small cut in your child's eardrum so the fluid can drain out. He or she may then insert ventilation tubes called grommets or tympanostomy tubes into the cut in the eardrum. These small, plastic tubes allow air to get in and out of the ear, which helps to drain the mucus. They can improve hearing for up to 10 months, but don't appear to offer any benefit in the long term. Grommets usually fall out after about six months to a year.

    An alternative operation to treat glue ear is an adenoidectomy. In this operation, your child's surgeon will remove their adenoids. In children over three, an adenoidectomy is usually done in the same operation as when grommets are inserted. However, adenoidectomy isn’t usually done unless your child keeps getting other symptoms, such as a blocked or runny nose (like the symptoms of a common cold).

    As with all surgery, there are risks involved with putting grommets in or having an adenoidectomy. These include infection or, with grommets, the possibility of permanent damage to your child's eardrum. Discuss the risks with your child's surgeon before you decide on treatment.

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  • Causes Causes of glue ear

    The exact reasons why your child may develop glue ear aren't fully understood at present. However, there are a number of things that can increase their risk of getting it.

    Children under six are most at risk of glue ear because their Eustachian tubes are still developing. This means they are smaller and can get blocked more easily.

    Glue ear may also be caused by enlarged adenoids. The adenoids are two small lumps of tissue similar to the tonsils, which sit at the back of the throat, beside the Eustachian tubes. If your child's adenoids are enlarged, they can block the Eustachian tubes.

    Your child’s risk of glue ear may also be increased by:

    • passive smoking
    • repeated colds and throat infections
    • hay fever or nasal allergies
    • bottle feeding or using a dummy
    • the season – glue ear is more common in winter than summer
    • their gender – boys tend to be affected more than girls
    • having a lot of contact with other children, such as at a nursery or playschool, or having lots of siblings
    • being born with a cleft palate, as this can affect the function of the Eustachian tube
    • having Down's syndrome, as this increases their susceptibility to infections
  • FAQs FAQs

    Do I need to take any precautions after my child's operation for grommets?

    Answer

    Recovery from an operation to have grommets put in is usually straightforward and most children have no problems. However, it’s important to follow your surgeon’s advice.

    Explanation

    The hole your surgeon will make in your child's eardrum when he or she puts grommets in is very small. Therefore, it's uncommon for an infection to develop, or for your child to have problems with normal day-to-day activities. It's safe for your child to fly after surgery for grommets. They can also go swimming a couple of weeks after a grommet operation but should keep their head above the water. It’s best not to dive or swim underwater as this increases the pressure. Your child shouldn't need to wear earplugs, although it’s fine if they prefer to do so.

    Dirty or soapy water may be more of a problem so your child should wear earplugs when they have a bath or shower. You can make your own waterproof earplugs by covering a small amount of cotton wool with petroleum jelly. You can also buy earplugs from your chemist or some audiology clinics. You will need to take these precautions until the grommets have fallen out. This usually takes between six months and a year.

    Some children develop an infection after a grommet operation. Infections after grommets aren't usually painful and your child may not seem ill. However, if you see a yellowish liquid coming out of your child's ear, see your GP for advice. Your GP may prescribe antibiotic eardrops for your child to take or a course of antibiotic tablets.

    How will I know if my child's hearing is affected?

    Answer

    Hearing loss can be difficult to identify because your child may not be aware of it. Hearing problems can affect behaviour and balance, so your child might seem more clumsy than usual. Your child may also have trouble concentrating, or become frustrated or irritable.

    Explanation

    Hearing problems are a sign of glue ear but they can be hard to spot. It can be particularly difficult if your child is very young and can't tell you that he or she is having trouble hearing. Hearing problems caused by glue ear may also come and go, which makes them even harder to notice.

    For a child with glue ear, sounds can seem muffled rather than disappear completely. Sometimes it might seem like your child is only hearing you when he or she wants to. You may not notice any problems at home, but your child's teacher or nursery worker might do. Some things to look out for include the following.

    • Your child may mishear what you say, particularly when you're talking and they aren’t looking directly at you. Your child may often ask you to repeat what you have said or have trouble hearing in a noisy environment. 
    • Your child might turn the television volume up or sit close to it. 
    • Because your child can't hear well, he or she might start to behave differently. Children can become withdrawn or have trouble concentrating, which can lead to frustration and irritability. 
    • Your child may appear to daydream or not pay attention. 
    • If your child is very young when he or she develops glue ear, this sometimes leads to a delay in the development of speech. For older children, hearing loss can affect other language skills, such as reading and writing, and they may start to struggle at school. 
    • Glue ear can cause balance problems and your child might seem to be more clumsy than usual.

    If you're worried that your child may have hearing loss, see your GP for advice.

    If your child is found to have glue ear, you may find it helps to:

    • get your child's attention before you start talking to him or her
    • speak to your child face-to-face and at their height
    • speak clearly with a normal volume and rhythm – don't shout
    • cut down background noise as much as possible, for example, turn off the television

    Let your child's nursery staff and teachers know about your child's glue ear too so that they can help your child.

    We're going on holiday soon, will my child be able to fly and swim in the pool when we get there?

    Answer

    If your child has glue ear and it hasn’t been treated, it may be painful to fly, depending on how severe their condition is. However, if your child has been treated, for example with grommets, they should be fine to fly.

    Explanation

    If your child has glue ear, their Eustachian tube may be blocked and this can stop air from getting into their middle ear. The air that is trapped in the middle ear is absorbed, reducing the pressure inside your child's ear and this can pull the eardrum inwards.

    If your child goes on a flight, further pressure changes when the plane is descending can be very painful. He or she will be less able, or even unable, to cope with the pressure change, depending on the severity of their condition. Your child may even be at risk of a perforated (torn) eardrum. Ask your GP for advice. He or she can assess how severe the glue ear is and if it will affect your child when flying.

    You might find that your child gets better before you travel. At least half of children with glue ear get better within three months and only a small number of children have persistent problems.

    If your child has had treatment for glue ear and had grommets inserted, it's perfectly safe for them to fly. The grommets will help air to move in and out of your child’s ear more easily. This will reduce stress on your child's eardrum and makes changes in air pressure easier to cope with. This will help to prevent pain when the plane is ascending or when it's coming down to land. Your child will also be able to swim, provided two weeks have passed since the operation. However, make sure your child doesn't dive or swim underwater.

    What kind of tests will my child have?

    Answer

    Audiometry, tympanometry and otoscopy are the main tests used to find out if your child has glue ear and whether their hearing is affected.

    Explanation

    Audiometry and tympanometry are the two main tests used to find out whether a child has glue ear and if it's affecting their hearing. An otoscopy can help rule out other conditions.

    Audiometry and tympanometry tests are usually done by an audiologist who specialises in identifying and treating hearing and balance problems. Your GP can refer your child to have these tests.

    Tympanometry is a test to find out how well your child's eardrum is working. A healthy eardrum is flexible and allows sound to pass through it and into your middle and inner ear. If your child has glue ear, their eardrum stiffens up because of the fluid behind it. Sound bounces off it rather than passing through. The stiffness can be measured and can show whether or not your child has glue ear.

    Tympanometry can be done with babies and young children because it doesn't test hearing and doesn't rely on getting a reaction from your child. Your specialist will place a small earpiece with a soft, rubber tip just inside your child's ear. He or she will use a pump to change the pressure in your child's ear and measure the amount of sound that bounces back. The results show up straight away.

    Audiometry will test your child's hearing. There are a number of different ways of doing an audiometric test depending on how old your child is. Each test will investigate your child's reaction to sounds that have different volumes and pitches.

    If your child is aged between six months and two years, he or she may have a visual reinforcement audiometry (VRA) test. Different sounds will be played and when your child hears them, he or she will turn towards the sound. As your child does this, he or she will be given a reward, for example, the toy will light up. The tester can gradually turn down the volume of the sound to find out the quietest sound your child can hear.

    Can changing my child's diet prevent or treat glue ear?

    Answer

    There is no evidence that changing your child's diet can prevent or treat glue ear.

    Explanation

    Some reports have suggested that changes to the diet, such as cutting out dairy products, can help glue ear. It's thought your diet may affect the amount of mucus your body produces, which may, in turn, build up and cause glue ear. Other reports suggest that dairy products and a large amount of sugar in the diet can increase the amount of mucus the body makes. Therefore, there was some thinking that cutting these out could reduce the amount of mucus and so help treat or even prevent glue ear.

    However, there isn’t any good quality scientific evidence to show that any changes in diet can treat glue ear.

    There is research to suggest that breastfeeding may reduce the chance of babies and young children developing glue ear. Breast milk may contain proteins that can help stop inflammation and help to protect against glue ear, even when your child no longer breastfeeds.

    What is most important is that your child eats a healthy, balanced diet. This should be low in saturated fat, sugar and salt, and high in fibre, vegetables and fruit.

  • Resources Resources

    Further information

    Sources

    • Map of Medicine. Otitis media with effusion. International View. London: Map of Medicine; 2014 (Issue 3) 
    • Surgical management of otitis media with effusion in children. National Institute for Health and Care Excellence (NICE), February 2008. www.nice.org.uk 
    • Epidemiological evidence for the effectiveness of the noise at work regulations. Health and Safety Executive. www.hse.gov.uk, published 2008
    • Otitis media with effusion. Medscape. www.emedicine.medscape.com, published 25 April 2013
    • Eustachian tube function. Medscape. www.emedicine.medscape.com, published 7 February 2013
    • Glue ear. ENT UK. www.entuk.org, accessed 10 March 2014
    • Otitis media with effusion in children. PatientPlus. www.patient.co.uk/patientplus.asp, published 13 December 2012
    • Otitis media with effusion. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published March 2011
    • Otitis media with effusion in children. BMJ Clinical Evidence. www.clinicalevidence.bmj.com, published 12 January 2011
    • van Zon A, van der Heijden GJ, van Dongen TMA, et al. Antibiotics for otitis media with effusion in children. Cochrane Database of Systematic Reviews 2012, Issue 9. doi:10.1002/14651858.CD009163.pub2
    • Tonsil and adenoid anatomy. Medscape. www.emedicine.medscape.com, published 22 February 2013
    • Rovers MM, Numans ME, Langenbach E, et al. Is pacifier use a risk factor for acute otitis media? A dynamic cohort study. Fam Pract 2008; 25(4):233–36. doi:10.1093/fampra/cmn030
    • Perera R, Glasziou PP, Heneghan CJ, et al. Autoinflation for hearing loss associated with otitis media with effusion. Cochrane Database of Systematic Reviews 2013, Issue 5. doi:10.1002/14651858.CD006285.pub2
    • Griffin G, Flynn CA. Antihistamines and/or decongestants for otitis media with effusion (OME) in children. Cochrane Database of Systematic Reviews 2011, Issue 9. doi:10.1002/14651858.CD003423.pub3
    • Browning GG, Rovers MM, Williamson I, et al. Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane Database of Systematic Reviews 2010, Issue 10. doi: 10.1002/14651858.CD001801.pub3
    • Recommended procedure. Visual audiometry reinforcement. British Society of Audiology. www.thebsa.org.uk, published June 2014
    • Recommended procedure – tympanometry. British Society of Audiology. www.thebsa.org.uk, published August 2013
    • Grommets. ENT UK. www.entuk.org, published 11 March 2014
    • Loo M. Integrative medicine for children. 1st ed. Missouri: Saunders Elsevier, 2009: 410–23
    • McDonald S, Langton Hewer CD, Nunez DA. Grommets (ventilation tubes) for recurrent acute otitis media in children. Cochrane Database of Systematic Reviews 2008, Issue 4. doi:10.1002/14651858.CD004741.pub2
    • Maternal and child nutrition. National Institute for Health and Care Excellence (NICE), March 2008. www.nice.org.uk 
    • Health tips for airline travel. Aerospace Medical Association. www.asma.org, accessed 11 March 2014
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