Glue Ear in Children (Otitis Media with Effusion)

Definition

Glue ear is a condition in which there is persistent catarrh filling the middle ear. The middle ear is a cavity deep to the ear drum which contains ossicles (small bones which conduct sound vibrations) and which is normally filled with air which gets into the middle ear from the back of the nose via the eustachian tube.

Incidence/Age

Glue ear is very common and is predominantly a condition of the first 7 years of life.

Causes

Glue ear occurs when the eustachian tube functions poorly. This results in inflammation of the lining of the middle ear and the replacement of the air it contains by sticky liquid. Eustachian function is poorer in childhood for a variety of reasons. These include anatomical factors, the presence of adenoids, frequent colds and nasal allergy. Other predisposing factors include family history and exposure to cigarette smoke. Children born with cleft palates are much more likely than average to suffer from glue ear.

Signs & Symptoms

Signs

Examination of the ear drum usually reveals the presence of visible catarrh, sometimes the surface tension of the liquid within the middle ear may cause retraction of the drum.

Symptoms

• Hearing Loss. This may be very noticeable with the child ignoring speakers that you would expect him/her to respond to or constantly asking for repeats. Often the hearing loss is more subtle with mishearing of similar sounding words, or sitting close to the TV. Unclear speech may be noted particularly in the younger age group.
• Ear Aches. These vary in severity from minor overnight twinges to full blown ear infections requiring medical attention.
• Behaviour Problems. Social isolation, frustration or very loud behaviour is noticed in some children.

Tests

Hearing tests usually to show a mild hearing loss. Tympanometry (a test designed to check middle ear air pressure) produces abnormal traces.

Treatment

Watchful waiting

At least half of newly diagnosed glue ear cases will resolve on their own within 3 months so active treatment is only required for more persistent cases.

Medical Treatment

There is little strong scientific evidence that medication makes any difference to the outcome of glue ear.

Antibiotics may be helpful in some cases particularly where recurrent infection is part of the clinical picture. Decongestants are occasionally used in an attempt to dry up catarrh. Steroid nasal sprays may be helpful in cases where nasal allergy is thought to be the underlying cause of the ear problem.

Hearing Aids

Hearing aids may be more helpful in some cases. They have advantages and disadvantages compared with grommets.

Otovent balloon

In older children a balloon inflated using the nose may be useful in ventilating the middle ear via the tube that links the back of the nose to the middle ear.

Surgery

The principle of surgery in glue ear is to allow reventilation of the middle ear. This is usually done with grommet insertion. A grommet is a small tube inserted into the ear drum allowing ventilation via the ear canal rather than via the eustachian tube. Removal of the adenoids may be performed at the same time.

Outcome

Glue ear usually gets better on its own, often within weeks or months. Improvement may however take a number of years during which the child will have symptoms and can fall behind at school. Ultimately it is nature which cures glue ear, the treatment being intended to minimise its adverse effects while the child grows out of it. Occasionally glue ear produces a permanent retraction of the ear drum and scarring of the middle ear leading to persistent hearing loss or more severe ear dise