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Glue ear

Expert reviewer, Mr Anil Banerjee, Ear, Nose and Throat Consultant
Next review due October 2019

Glue ear is a build-up of fluid in your middle ear that can cause problems with hearing. It’s a common condition in children. In most cases, you won’t need treatment because it gets better on its own. If it does last for longer, there are different treatments available that can help.

About glue ear

You can get glue ear after a middle ear infection or similar conditions that cause inflammation in this area. It happens when the tube between your middle ear and the back of your throat, the Eustachian tube, becomes blocked. Air can’t then enter the middle ear and it begins to fill with fluid. There are three little bones (ossicles) that pass sound vibrations across your middle ear. The build up of fluid in glue ear makes it difficult for these bones to move freely. This makes it harder for sounds to pass through the middle ear to the inner ear.

Eight out of 10 children have had glue ear at least once by the time they are 10. It’s most common between the ages of one and six. Adults can also get glue ear but it’s far more common in children.

In most cases glue ear goes away by itself within about three months. However, in some cases it can last much longer and lead to your child having problems with education, language development or behaviour.

The medical name for glue ear is otitis media with effusion (OME).

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.

Symptoms of glue ear

If your child has glue ear, they won’t necessarily complain of any symptoms. However, their ear may feel bunged up, they may get mild ear pain and they might feel ‘popping’ in their ear. Their hearing may be poor. This can be mild at first so your child might not notice it happening. It can be particularly difficult if your child is very young and can’t tell you that they’re having trouble hearing. 

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

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. They may often ask you to repeat what you’ve 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, they might start to behave differently. Children can become withdrawn or have trouble concentrating, which can lead to frustration and irritability.
  • If your child is very young when they develop glue ear, this sometimes leads to a delay in the development of speech. Older children may start to struggle at school.

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

Diagnosis of glue ear

Your GP will ask about your child’s symptoms and examine them. They may also ask about your child’s medical history, especially whether they’ve had a lot of ear infections.

Your GP will look at your child’s eardrum using an instrument called an otoscope. This is a small, hand-held device which has a magnifying glass and a light. 

Your GP may monitor your child over six to 12 weeks. This is to see if the glue ear gets better, and 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
  • 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 below.

Treatment of glue ear

Most children with glue ear don’t need any treatment because it gets better on its own. At least half of children with glue ear get better within three months without any treatment. Around 95 out of 100 children get better within a year. 

Non-surgical treatments 

Antibiotics, antihistamines and decongestants aren’t recommended for glue ear. Nor are complementary therapies such as homeopathy, osteopathy, acupuncture, ear candles or special diets. 

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.

Your doctor may suggest a technique called autoinflation. Autoinflation involves your child using their nose to inflate a special balloon. This increases pressure in their nose and may help to open up the tube between their ear and the back of the throat (Eustachian tube). This aims to let air into their middle ear so the fluid there can drain out. Doctors think that autoinflation might help glue ear, and it doesn’t seem to cause any harm.

Surgery

Your doctor may suggest surgery if your child’s condition hasn’t improved after three months and they have severe hearing loss. Surgery may also be offered if your child’s hearing loss is affecting their learning or development. However, it’s worth bearing in mind that nearly all children who have glue ear get better within a year without treatment. 

The main type of surgery for glue ear is to make a tiny cut in the ear drum (myringotomy) and to insert a grommet.

Grommets

Grommets are tiny plastic tubes that can be placed in your child’s ear. They work by allowing air to get in and out of the middle ear, which helps to drain the fluid there. Grommets are usually put in with a general anaesthetic, which means your child will be asleep during the procedure.

Grommets are used to treat persistent glue ear and can improve hearing for up to nine months. But they don’t appear to improve speech or language development in the long term. Grommets usually fall out after about six months to a year. 

Adenoidectomy

Another type of surgical treatment for glue ear is an adenoidectomy. In this operation, your child’s surgeon will remove their adenoids – lumps of soft tissue at the back of the nose (like tonsils). For children of three years and over, surgeons often recommend that they have their adenoids removed at the same time as having grommets put in. This is because a study has shown that this may give extra benefits in children of this age. It may improve how well they can hear and help them avoid further cases of glue ear.

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.

Causes of glue ear

Doctors aren’t completely sure why glue ear happens. Several different factors are involved, but in more than a half of cases glue ear seems to follow an infection of the middle ear.

Children under six are most at risk of glue ear. This is because their Eustachian tubes (the tube between the middle ear and the back of the throat) are still developing. The tubes are smaller and more horizontal and so can get blocked more easily. 

Glue ear may also be caused by infected or 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: 

  • someone in the household 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 in 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 the chance that they’ll get an infection

There may be other factors causing glue ear in an adult. See our frequently asked question on glue ear in adults below for more information.

Frequently asked questions

  • Adults can get glue ear, but it’s far more common in children. Treatment for glue ear in adults is generally the same as for children. Adults are more likely than children to get it in one ear only. If you have glue ear as an adult you’ll probably notice some loss of hearing. Your ear may feel ‘full’ and you may hear popping or crackling sounds. It doesn’t usually cause pain.

    In adults, glue ear may follow an infection of the ear, nose or sinuses. You may also get glue ear if you have severe or persisting allergies. Some people get glue ear after flying, or after scuba diving. 

    If you have glue ear as an adult it’s important to get it checked out by your GP.

  • Most children who have grommets put in have no problems afterwards. Your surgeon will give you advice about when your child can start swimming again, and about keeping soapy water out of their ears. Otherwise your child can carry on with their normal activities. It’s important to follow any advice your surgeon gives you.

    Swimming

    Your child can 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.

    Bathing/showering

    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’ll need to take these precautions until the grommets have fallen out. This usually takes between six months and a year.

    Flying

    It’s safe for your child to fly after surgery for grommets.

    Infections

    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, speak to your GP for advice. They may prescribe antibiotic eardrops for your child to take or a course of antibiotic medicine.

  • In most cases glue ear goes away by itself, but this can take a few months. In the meantime, there are lots of things you can do to help your child communicate.

    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 them
    • 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.

  • Children with glue ear don’t generally have problems flying. But 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. If your child has been treated with grommets, they should be fine to fly.

    More information

    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. They may not be able to cope with the changes in cabin pressure during take-off and landing, which can cause discomfort for them. Your child may even be at risk of a perforated (torn) eardrum, although this is extremely rare.

    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.

  • There are two main types of tests used to find out if your child has glue ear and whether their hearing is affected. Tympanometry assesses how well their eardrum reacts to sound, and audiometry tests their hearing. These tests are usually done by an audiologist who specialises in identifying and treating hearing and balance problems.

    Tympanometry

    This 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.

    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 child will need to keep still during the test, but it doesn’t hurt. Your audiologist will place a small earpiece with a soft, rubber tip just inside your child’s ear. They’ll use a pump to change the pressure in your child’s ear and measure the amount of sound that bounces back. This takes less than a minute for each ear.

    Audiometry

    This 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, they may have a visual reinforcement audiometry (VRA) test. Different sounds will be played and when your child hears them, they’ll turn towards the sound. As your child does this, they’ll be given a reward, for example, a toy will light up. If your child is older the audiologist may play sounds through headphones on your child’s head. They’ll then ask your child to respond when they hear a sound.

  • 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.

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

    Experts think that breastfeeding may reduce the chance of babies and young children developing glue ear. And if you bottle feed your baby it may be best not to lay them completely flat while they are feeding. This may help to keep their Eustachian tubes (tubes from the back of the throat to the middle ear) clear.


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Related information

    • Otitis media with effusion. Medscape. emedicine.medscape.com, updated 5 October 2016
    • Otitis media with effusion. PatientPlus. patient.info/patientplus, last checked 2 February 2016
    • Otitis media (secretory). The MSD Manuals. www.msdmanuals.com, last full review/revision December 2015
    • Otitis media with effusion. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised March 2011
    • Surgical management of otitis media with effusion in children. National Institute for Health and Care Excellence (NICE), February 2008. www.nice.org.uk
    • Map of Medicine. Otitis media with effusion. International View. London: Map of Medicine; 2014 (Issue 3)
    • Glue ear (OME). ENT UK, The Royal College of Surgeons of England, 2012. entuk.org
    • Grommets. ENT UK, The Royal College of Surgeons of England, 2015. entuk.org
    • Glue ear. National Deaf Children’s Society (NDCS). www.ndcs.org.uk, accessed 13 October 2016
    • Glue ear. Action on Hearing Loss. www.actiononhearingloss.org.uk, published June 2016
    • MRC Multicentre Otitis Media Study Group. Adjuvant adenoidectomy in persistent bilateral otitis media with effusion: hearing and revision surgery outcomes through 2 years in the TARGET randomised trial. Clinical Otolaryngology 2012; 37:107–16. doi: 10.1111/j.1749-4486.2012.02469.x
    • Different types of hearing tests. National Deaf Children’s Society (NDCS). www.ndcs.org.uk, accessed 13 October 2016
    • Visual Response Audiometry (VRA). National Deaf Children’s Society (NDCS). www.ndcs.org.uk, accessed 13 October 2016
    • Pure tone audiometry. National Deaf Children’s Society (NDCS). www.ndcs.org.uk, accessed 13 October 2016
    • 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
    • Tympanometry. British Society of Audiology, 2013. www.thebsa.org.uk
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, October 2016
    Expert reviewer, Mr Anil Banerjee, Ear, Nose and Throat Consultant
    Next review due October 2019



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