Glue ear is one of the most common childhood illnesses.
Children under the age of five are the largest group affected, though for some it can persist into adolescence. It is widely accepted that glue ear can cause temporary deafness, delayed speech development in young children and affect children’s behaviour and their educational progress.
Glue ear is often, but not always, linked with ear infections. It can sometimes develop unnoticed. Changes in behaviour, becoming tired and frustrated, lack of concentration, preferring to play alone and not responding when called may indicate glue ear. These signs can often be mistaken for stubbornness, rudeness and being naughty. As a result many children with glue ear are misunderstood or labelled as ‘difficult’.
A prolonged period of time with reduced hearing can affect the way in which a child’s speech develops. For example, parts of words may not be pronounced clearly. Children with glue ear may also fall behind at school and become disruptive if they do not have extra support.
For ears to work properly the middle ear needs to be kept full of air. The Eustachian tube, which usually does this, runs from the middle ear to the back of the throat. In children this tube is not as vertical and wide as it will be when they get older and as a result doesn’t work as well. If the Eustachian tube becomes blocked, air cannot enter the middle ear. When this happens, the cells lining the middle ear begin to produce fluid. This can be like a runny liquid which can get thicker as it fills the middle ear.
With fluid blocking the middle ear, it becomes harder for sound to pass through to the inner ear. This can make quieter sounds difficult to hear. It can be like listening to the world with both fingers stuck in your ears. It’s hard work, try it for yourself! If your child has glue ear they can’t always hear everything that you say, so it’s no wonder they’re tired and irritable, or just want to be left on their own.
There are many different things that can contribute to glue ear. These include colds and flu, allergies and passive smoking. Children with cleft lip and palate, or with genetic conditions, such as Down’s syndrome, may be more likely to get glue ear as they may have smaller Eustachian tubes.
Often glue ear is associated with a heavy cold and will clear up when the congestion from the cold has gone. Mild cases of infection can be treated with paracetamol (such as Panadol) .
See your family doctor if your child:
• Has a high fever or bad earache
• Has an ear discharge that lasts more than 24 hours
• Seems to be getting worse or you are worried at any time.
If you are worried about your child’s hearing, arrange an appointment with your family doctor (GP). Your GP will examine your child’s ears and should be able to tell if glue ear is present. If there is any pain or sign of infection your GP may prescribe a course of antibiotics. Your GP may want to wait to see if the glue ear clears up by itself before referring your child to an ENT specialist.
Your child may require a referral to an ENT specialist. The ENT will examine your child’s ears and a further assessment might be carried out. This may include a tympanometry test, which measures how well the eardrum can move. If there is fluid in the middle ear the eardrum will not work properly. The test should take about a minute to do. A graph (called a tympanogram, see diagram below) will show the results straight away. A hearing test should also be done to check if the glue ear is affecting your child’s hearing and by how much. The tests used will depend on your child’s age.
The ENT should explain the results of all the tests used and discuss the best way to treat your child. It is a good idea to monitor the glue ear with repeated tests at least three months apart. This is known as ‘watchful waiting’. For most children, the glue ear will clear up in this time. If it has not, you may be offered grommets.
These are tiny plastic tubes that are put in the eardrum. This is done during a short operation at hospital under general anaesthetic. The grommets are inserted after the fluid in the middle ear has been drained away. The grommets allow air to circulate in the middle ear and stop more fluid from building up. The surgeon may talk to you about removing your child’s adenoids at the same time. Adenoids are glands that sometimes become infected and swollen.
Grommets usually stay in until the eardrum has healed and pushed them out. Sometimes the fluid comes back, and another grommet operation may be considered. The specialist doctor should always discuss any risks of operating again with you before you make a decision.
Children’s hearing can be affected for long periods of time while waiting to see if the glue ear clears up naturally or while on the waiting list to have the grommet operation. It is important to make sure that a child’s speech and education does not suffer during this time. You may want to consider hearing aids, or asking for extra support at school.
Research suggests that breast-feeding may reduce the risks of babies and young children developing glue ear. It is thought that breast milk contains proteins which can help stop inflammation and help to protect against glue ear even when breast-feeding has stopped.
Research carried out by the Department of Health has shown that all children are more likely to get ear infections and glue ear if they are often in a smoky environment. A child is likely to experience glue ear for as long as the environment remains smoky.
Parents should try to make their children’s environment smoke-free. The environment includes the home, car, crèche, playgroup or school. If it is not possible to make the environment entirely smoke-free, then smoking should be confined to an area not used much by children. It is important to remember that simply opening a window is not enough, as many dangerous smoke particles will stay in the air.
In 2008, the National Institute of Clinical Excellence (NICE) published guidance about glue ear for the NHS in England and Wales. Having studied all the research evidence currently available they made recommendations on the use of various treatments for glue ear. Their recommendations are based on the treatments that effectively treat glue ear for the greatest numbers of children who have the treatment. For some treatments there may be very little or poor quality evidence available that has been documented. This might be because it is still quite a new treatment. Alternatively the treatment may be offered by the alternative or complementary health sector who do not tend to produce the type of scientific research evidence reviewed by NICE. NICE recommended grommets or hearing aids as effective treatments for glue ear.
At the current time they do not recommend using:
Steroids • Antihistamines • Decongestants • Antibiotics • Homeopathy • Cranial osteopathy • acupuncture • Massage • Probiotics • Changing the diet (eg to reduce dairy) • Immunostimulants
A copy of the guidance written for patients and carers is available to download from the NICE website.
It is important that glue ear is identified as soon as possible and that parents and teachers know how it can affect children’s hearing. Basic communication tips can help to make listening easier for your child.
It is important to get your child’s attention before you start talking. Make sure you face your child as much as possible, and keep eye contact. Check that background noise is kept to a minimum. Speak clearly, without shouting and maintain your normal rhythm of speech.
The teacher may realise that your child is having problems, but may not be aware that this is because of their hearing. It is important that you tell the teacher about your child’s hearing so that arrangements can be made in school to help. It is important that your child is able to sit near the teacher in the classroom, that they understand what is said and that they are not made to feel awkward about asking for things to be repeated.
14-Nov-2015 6:10 PM (AEST)