Glue Ear
What is glue ear?
Glue ear is an accumulation of fluid within the middle ear. The middle ear is the space where sound is transmitted from the eardrum to the inner ear. The presence of fluid may impede the transmission of sound causing a hearing loss.
The consistency of fluid is usually thick and viscous, hence the term "glue". The fluid is produced by mucous glands in the middle ear and is essentially similar to the mucus that is produced in the nose.
The condition is very common in children from the ages of 2 to 5 and occurs mostly in the winter. An ear infection or a cold may precipitate the development of glue ear and in most children the glue ear resolves within a few weeks after onset. In some children it may persist and lead to a hearing impairment. Generally if it is present for more than 3 to 4 months it is likely to continue.
Treatment options will depend on degree and impact of the hearing loss. This may have an effect on speech development in younger children and if speech is a concern, then some children may compensate by having speech therapy. There may be behavioural issues, including children becoming easily frustrated and tired, withdrawing from larger groups of children and noise intolerance. Non interventional treatment with hearing aid amplification is an option but is rarely taken up by parents.
Other treatments include long term antibiotics and nasal steroids, but these are often not effective and parents are reluctant to use regular medication.
The Otovent device is a balloon that is inflated by blowing through one nostril and this in turn attempts to open the eustachian tube with positive pressure. Older children are able to use this and may find this helpful.
How do I know if my child has a hearing loss?
Hearing tests
Detecting a hearing impairment in children can be difficult. In the UK there is a system of screening for deafness at birth. This is usually performed in either a hospital setting or in the community with objective hearing tests. These tests are either an otoacoustic emission or an automated auditory brainstem response. The otoacoustic emission test indicates if the cells within the cochlear are functioning normally and the auditory brainstem response assesses the integrity of the auditory pathway.
Subjective assessments of hearing can be difficult in infants. Until a child is able to move their head, the only indication that a child may not hear is if they do not startle in response to a loud noise. At about 3 months when a child starts to turn his/her head, then this gives more indication whether a child is able respond reliably to sound. As children get older, it becomes easier to subjectively assess their hearing. Until the age of 3 and a half, play or visually reinforced audiometry are used to assess hearing thresholds. Pure tone audiograms can only reliably be performed in children over 3 and a half.
Indications that there may be a hearing problem
The most common reason for parents bringing their children for a hearing assessment is because of concerns about their speech. There is a lot of variation in the age at which children learn to speak. At about 2 years children should have 20-30 words. By 3 they should be able to formulate simple sentences. There is much variation in this and a number of factors may influence speech progression, including use of more than one language and the presence of older siblings.
Although there may be clear signs that a child does not respond to being called, this is not always obvious. However there are often subtle indications.
Children may prefer one-to-one company and avoid large groups of other children where they have trouble hearing in background noise. This can be particularly noted at birthday parties, when children with glue ear tend to prefer to shy away from the noisy environment. Often children with glue ear will find that loud noises are uncomfortable. They may also have a tendency to lose their temper without any obvious reason, as they are working hard to try and hear.
Younger children with glue ear may not have clear articulation. This is particularly notable with some consonants and they may miss the beginnings and ends of words.
The hearing loss in glue ear is usually in the low frequency sounds and this may be evident where children may not be able to hear their fathers as well as their mothers.