Glue ear

Published by Bupa's Health Information Team, December 2011.

This factsheet is for parents of children with glue ear, or for people who would like information about it.

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 and some children may need surgery to help clear the ear.

Animation – how glue ear develops

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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 throat and opens when you swallow. This allows air to pass up and down the tube from your throat to the middle ear and in the opposite direction. This equalises the air pressure inside your ear to the air pressure outside your ear. When it’s inflamed, the Eustachian tube doesn’t open properly and so mucus stays in the middle ear.

About glue ear

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

A blocked Eustachian tube can stop air from getting into the middle ear. The air that is trapped in the middle ear is absorbed, reducing the pressure inside your child's ear and pulling the eardrum inwards. A sticky fluid builds up inside the middle ear and affects your child’s hearing, since the middle ear is filled with liquid rather than air.

Glue ear is very common in children – eight out of 10 children will have had the condition at least once by the time they are 10.

Symptoms of glue ear

Unlike a middle ear infection, which can often cause earache, a high temperature and other signs of illness, if your child has glue ear, he or she won't necessarily complain of any symptoms. However, his or her hearing may be poor and their ear may feel bunged up. This can come on gradually, so your child may not notice it happening.

As a result of this hearing impairment, your child may have problems paying attention or interacting with others, as well as interfering with the development of his or her speech and language. Your child may also appear clumsy and have trouble with balance.

Causes of glue ear

Children under six are most at risk of glue ear because their Eustachian tubes are still developing. This means they can get blocked more easily. Boys tend to be affected more than girls and the condition is more common in winter than summer.

Many children with glue ear get it as a result of a bout of inflammation of the middle ear. If your child has nasal allergies to pets or dust, or has hay fever, he or she may be more likely to develop glue ear. Inflammation caused by the allergic reaction may cause their Eustachian tubes to swell and become blocked more easily. This can be a cause of recurring glue ear.

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 or, if inflamed, can cause inflammation in the Eustachian tube entrances.

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

• passive smoking – if either parent smokes, a child is at higher risk
• repeated colds and throat infections
• having brothers or sisters with glue ear
• bottle feeding or using a dummy

Your child is also at increased risk if he or she has a lot of contact with other children, for example, at a nursery or playschool, or has lots of siblings. In addition, children who are born with a cleft lip or palate, or who have Down's syndrome are more likely to get middle ear infections, making them more susceptible to glue ear.

Diagnosis of glue ear

Your GP will ask about your child's symptoms and examine your child. He or she will use an instrument called an otoscope to look at your child's eardrum. He or she may also ask about your child’s medical history.

For most children, glue ear doesn't become a long-term problem. At least half of children with glue ear get better within three months, and 95 out of 100 children get better within a year. Only a small number of children have persisting problems.

Your GP may need to monitor your child if he or she has persistent glue ear or repeated bouts of it to make sure their hearing and language isn't affected. After your child has glue ear, your GP may ask to see your child two to three months later for a check-up. Your GP may ask for extra information from your child’s school (if relevant) and refer your child to a speech and language therapist.

Treatment of glue ear

If your child’s condition hasn’t improved after three months of monitoring, there is a persistent foul-smelling discharge from their ear, they have severe hearing loss, or if he or she has a disability, such as Down's syndrome, your GP may suggest a hearing test.

Also, your child may be referred to an otolaryngologist (a doctor who specialises in conditions that affect the ear, nose and throat), also known as an ENT specialist. Alternatively, your child may be referred to an audiological paediatrician (a doctor who specialises in conditions that affect childrens’ hearing).

Non-surgical treatments

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

There is some evidence that a technique called autoinflation may help. In this technique, your child uses his or her nose to inflate a special balloon (called an Otovent, which can be bought from some pharmacies). This increases pressure in their nose and may help to open up the Eustachian tube. This aims to let air into the 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 into the long-term effects.

Your GP will give you more information about the available treatment options.

Surgery

After your doctor has monitored your child's condition for three months, he or she may suggest that your child has surgery. It’s recommended for children who have severe hearing loss.

Surgery may involve a procedure called a myringotomy in which a small cut is made in your child's ear drum so the fluid can drain out. Ventilation tubes called grommets or tympanostomy tubes are then inserted into the cut in your child's eardrum. These small plastic tubes allow air to get in and out of the ear, equalising the pressure. They can be effective at improving hearing for up to 10 months, but don't appear to offer any benefit in the long term. Grommets usually fall out after about nine months to a year.

If your child has grommets, it's fine to go swimming although your child shouldn’t dive or put his or her head underwater (even in the bath).

Alternatively, it may help if your child has an operation to remove his or her adenoids. This is called an adenoidectomy.

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 deciding on treatment.

Once your GP has diagnosed persistent glue ear, it's important that your child has regular hearing checks. A hearing aid may be useful if surgery isn't an option.

For answers to frequently asked questions on this topic, see Common questions .

For sources and links to further information, see Resources .