Glue Ear (or Otitis Media with Effusion)
This is something that impacted Master G as a young baby and resulted in ‘grommets and adenoid’ surgery at 1 year of age. It is also a condition that, if untreated, can cause speech and language delay due to hearing loss caused by the fluid build up. Any hearing loss is usually rectified once the glue ear has been effectively treated.
Glue Ear is different to an acute ear infection in that it often does not have symptoms unless balance is affected or if there is hearing loss. It is common in under 2 year olds but can occur at any age, this can be because young children have shorter, more horizontal and straighter eustachian tubes than in older children/adults which can make it easier for bacteria to enter (1). The eustachian tubes connect the ear to the back of the throat (as seen in the diagram below) and help drain fluid to prevent build up in the ear. If this tube is blocked, drainage can be prevented. Causes of this can be:
- Mucous from a cold or upper respiratory tract infection
- Allergies causing swelling or irritation
- Irritation from the environment such as cigarette smoke
- Day care attendance (can result in higher incidence of common cold illnesses)
- Infant feeding while lying down.
Young children often suffer with colds more as they are busy building up their immunity which can contribute to the incidence of Glue Ear, although the eustachian tubes tend to mature around the age of 6 years which can make ear infections less common after that age regardless of the number of viral illnesses (2).
Glue Ear is closely related to acute otitis media (ear infection) in that fluid can persist behind the ear drum following an ear infection for a few days or weeks. Conversely, children with glue ear are more prone to acute ear infections. Approximately one in three children with glue ear will have bacteria identified in the middle ear fluid (3).
Diagnosis of Glue Ear can be as simple as your Gp looking in the ears, throat and nasal passages with an otoscope. Your ENT specialist and Audiologist will do slightly more detailed tests, which will be discussed shortly, but none of these are painful or invasive.
Initial treatment of Glue Ear will differ from Gp to Gp. Most will have a wait and see approach for 2-3 months, preferring to see if the fluid resolves itself before giving antibiotics or referring to a specialist. This is usually only if the child does not have symptoms such as hearing loss, speech delay or recurrent symptomatic ear infections over a period of 6 months to 1 year (4). The medical history of the individual child is also taken in to account when deciding the course of treatment.
A review of 23 studies, involving 3027 children in total, found that the use of antibiotics to treat Glue Ear did not show evidence of a substantial improvement in the hearing of children with Glue Ear, nor did it affect the number of children who required grommets to drain the fluid, supporting the current practice that children with Glue Ear should not be routinely treated with antibiotics (3).
Referral to an ENT specialist can be requested from your Gp, without waiting to see if the fluid resolves, if you as a parent feels that there is hearing loss, speech delay, or that you would prefer to have a full assessment done sooner rather than later to put your mind at ease.
Once a referral is made to the ENT specialist of your choice if choosing to use private healthcare, or to your local paediatric ENT department if using public healthcare, you can usually expect your doctor to take a full medical history and look in your child’s ears, nose and throat just like your Gp did. Often the specialist will request that a hearing test be done, sometimes prior to your initial appointment. Most will have this facility within their private practice or you will be directed to the Audiology department in the hospital within your appointment time. The hearing test is simple and painless. It is usually done by Audiologists specialising in children and is adapted for the age of the child.
The Audiologist may also do Tympanometry, where a device is used to block the ear canal and adjust the air pressure within the ear to assess the movement of the ear drum. How well the ear drum moves can measure the pressure in the middle ear. Pneumatoscopy may also be used, where the specialist can look in to the ear while also causing a puff of air to blow against the ear drum in order to see how much the ear drum moves for an indication of how much fluid may be behind the ear drum (5). Neither of these procedures is painful or invasive.
Your specialist will then discuss with you the results of the hearing test and any other tests that have been performed. Treatment options will depend on the results of the test and medical history of the child.
If surgical treatment is required, insertion of grommets (tubes/tympanostomy tubes) into the ears is usually the treatment of choice. Occasionally this may also include removal of adenoids, these are lymph nodes at the back of the nose which can contribute to middle ear infections and glue ear when inflamed (2). Very occasionally a tonsillectomy may also be discussed.
I’ll talk more about what is involved in surgery to insert grommets and remove adenoids in my next post….stay tuned 🙂
1. Otitis Media with effusion. MedlinePlus Medical Encyclopedia 2015. Retrieved 2015 from http://www.nlm.nih.gov/medlineplus/ency/article/007010.htm
2. Ear problems in children. Better health channel, Victoria 2012. Retrieved 2015 from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Ear_problems_in_children
3. Antibiotics for otitis media with effusion. van Zon, A; van der Heijden, G. 2012. REtrieved 2015 from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009163.pub2/abstract
4. Otitis Media (Ear infections) and complications. Perth ENT centre 2015. Retrieved 2015 from http://www.entkids.com.au/education
5. Ear infection (middle ear). Mayo Clinic 2013. Retrieved 2015 from http://www.mayoclinic.org/diseases-conditions/ear-infections/basics/tests-diagnosis/con-20014260