Glue Ear

** Please see the link at the bottom of this page for a short informational video on Glue Ear & Grommet Insertion**

What is glue ear?

Glue ear is an accumulation of fluid within the middle ear that can lead to hearing loss.

The middle ear is the space where sound is transmitted from the eardrum to the inner ear.  The presence of fluid in this cavity impedes the transmission of sound.

Anatomy of the ear

The consistency of the 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 persist.

Impact of glue ear

In younger children (around 2-3) there may be an effect on speech development and this the age is when a hearing loss has the greatest impact. Children may miss the beginnings and ends of words and mix up certain consonants such as "b" and "p."

 Behavioural issues can also occur, with children becoming easily frustrated and tired,  "losing it", withdrawing from larger groups of children. Some children experience loudness intolerance particularly the hoover and hairdryers 

Being easily distracted and a lack of attention may  also  be noted by school teachers

How can Glue Ear be treated?

Treatment options will depend on the degree and impact of the hearing loss and not all children need treatment. 

Non-interventional treatment with hearing aid amplification is an option but is not usually popular with children or their parents.

Other treatments include long term antibiotics and nasal steroids, but these are non proven a 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 (>4 years) should be  able to use this.

 

How can I tell if my child has a hearing loss?

Indications that there may be a hearing problem

Although there may be clear signs that a child does not respond to being called, this is not always obvious. However, there are other more subtle indications that a child with glue ear is having issues with their hearing:

  • 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, where children with glue ear tend to prefer to shy away from the noisy environment. 
  • some children will find that loud noises are uncomfortable
  • others 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 associated with glue ear is usually in the low frequency sounds and be apparent when children are unable to hear their father as clearly as their mother 

The most common reason for parents bringing their children for a hearing assessment is because of concerns about their speech. 

It should be noted that 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, and by 3 they should be able to formulate simple sentences. Even this is just a guideline, though, as a number of factors may influence speech progression, including use of more than one language and the presence of older siblings.

Hearing tests

Detecting a hearing impairment in children can be difficult. 

In the UK there is a system in place to screen for deafness at birth.  This is usually performed either in a hospital 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 of hearing difficulties is if they do not startle in response to a loud noise. As children get older, it becomes easier to subjectively assess their hearing: 

  • at about 3 months when a child starts to turn their head, then this gives more indication whether they are able to respond reliably to sound
  • until the age of 3 and a half, play or visually reinforced audiometry are used to assess hearing thresholds
  • after 3 and a half pure tone audiograms can be reliably performed