Glue Ear / Otitis Media with Effusion
What is it?
Glue Ear, or Otitis Media with Effusion (OME), is fluid in the middle ear, behind the ear drum. Unlike Acute Otitis Media, Glue Ear doesn't cause much pain. However, many children suffer with both Glue Ear and Acute Otitis Media. The main problem with Glue Ear is hearing loss. For many children, this would be like having fingers blocking the ears. Because they can't hear, children can also then suffer with speech problems or poor school performance. But many children have Glue Ear with only minimal symptoms.
Adenoids sit at the opening of the Eustachian tube at the back of the nose
See also Action on Hearing Loss and ENTUK websites.
What causes it?
This question has been researched quite a lot! People used to think it was because the Eustachian tube was blocked, and that prevented fluid draining from the middle ear. The Eustachian tube connects the middle ear to the back of the nose, and where it sits in the nose is also where the adenoids are. Have a look at section on adenoids.
However, we now know that it is more complex than that. Eustachian tube problems do contribute to Glue Ear, but probably because the tube is more likely to let bacteria (from the nose and the adenoids) enter the middle ear, rather than due to any physical blockage. Children's Eustachian tube is shorter and flatter than in adults, that's why children are more likely to get middle ear disease related to poor Eustachian tube function than adults. We now think that Glue Ear is caused by a chronic, low grade infection called a biofilm infection. Such infections do not respond to antibiotics, so there is no role for antibiotics in Glue Ear treatment. Glue Ear sometimes also runs in the family, which means that genetic factors contribute to its development.
What can I do to help?
If your have concerns about your child's hearing, you need to find out why this is. Go to see your GP, or refer yourself to the children's audiology department for a hearing tests. Many children's audiology departments take referrals direct from parents, so there is no need to ask your GP for a referral. (Audiologists are specialists in assessment of hearing and other aspects of ear function).
Make sure that you catch the child's attention before speaking, for example by catching their eye or tapping their shoulder. Face the child when you are talking, and switch off background noise. Point to what you are talking about, and don't cover your mouth. Don't shout, and don't speak too fast.
Make sure school or nursery know about the Glue Ear, and follow the same rules. The child would be best placed somewhere close to the front of the class.
Make sure that no one smokes around the child, and remember that even smoking away from the child will still bring smoke particles on your clothing and hair to the child and may contribute to Glue Ear.
You could also encourage your child to pop their ears regularly, or use the Otovent Balloon. Both methods send a bubble of air up the Eustachian tube, encourage the Eustachian tube to work better, and this allows Glue Ear to recover. The Otovent Balloon is a balloon that the child inflates using the nose. This makes it a fun game to play with children. Have a look at the Otovent page.
There is also an app designed to help children with Glue Ear.
The app is called Hear Glue Ear, and is intended to support parents,
give information about Glue Ear, and help children manage the hearing loss.
It is available on Apple and Android.
How is Glue Ear treated?
Lots of children get Glue Ear, practically everyone will at some stage. But in most cases, it just gets better. Therefore, in the first instance, we would just wait to see what happens and repeat testing in three months. This is called watchful waiting. During the watchful waiting period, you can try the Otovent Balloon, or the Hear Glue Ear App.
Some children have Glue Ear but minimal or no hearing loss, in those circumstance usually no treatment will be offered.
Glue Ear often fluctuates as well, so it is common to see hearing levels vary quite a lot from test to test. If we see that hearing is returning to normal, usually no treatment will be offered. This is because the body is managing to correct the problem at least some of the time, and children catch up during those good periods.
One sided Glue Ear is usually also not treated, because majority of daily functions can be carried out well as long as one ear hears normally. If your child has one-sided hearing loss, make sure that majority of of the communication is directed to the child face-on or to the good side, and not to the bad side!
Glue Ear management is based on recommended guidelines such as those from the National Institute for Health and Care Excellence. Grommet surgery is not funded by the NHS unless specific criteria are met. Have a look at the grommets page to see what will need to happen before surgery will be funded.
What about adenoids and Glue Ear?
The adenoids contribute to development of Glue Ear, so it is logical to think about removing them as a treatment for Glue Ear. Remember the adenoids sit around the Eustachian tube opening in the nose, and the bacteria from the adenoids travel up the Eustachian tube into the middle ear. The main treatment of Glue Ear is grommets, as this deals with the Glue Ear fluid, but you may also hear your doctor talk about adenoid removal. For Glue Ear, removing adenoids is something that surgeons usually consider in children aged 4 years or older, if they have lots of snotty noses and upper respiratory tract infections.
Glue Ear: fluid in the middle ear, behind the ear drum