Glue Ear [Serous Otitis Media]
Glue ear is a condition where the middle ear fills with glue-like fluid instead of air. This causes dulled hearing. It clears by itself in most cases. Treatment with a balloon that is blown up by the child using their nose may help in some cases. An operation to clear the fluid and to insert grommets may be advised if glue ear persists.
What is the ear like and how do we hear?
The ear is divided into three parts - the outer, middle, and inner ear. Sound waves come into the outer (external) ear and hit the eardrum causing the eardrum to vibrate. Behind the eardrum, in the middle ear, are three tiny bones (ossicles) - the malleus, incus, and stapes. The vibrations pass from the eardrum to these middle ear bones. The bones then transmit the vibrations to the cochlea in the inner ear. The cochlea converts the vibrations to sound signals which are sent down the ear nerve to the brain which we 'hear'.
The middle ear behind the eardrum is normally filled with air. The middle ear is connected to the back of the nose by a thin channel, the Eustachian tube. This tube is normally closed. But, from time to time (usually when we swallow or yawn), it opens to let air into the middle ear, and to drain any fluid out.
What is glue ear?
Glue ear is a condition where the middle ear becomes filled with fluid that looks like glue. It can affect one or both ears. The fluid dampens the vibrations of the eardrum and bones (ossicles) made by the sound waves. The cochlea receives dampened vibrations, and so the 'volume' of the hearing is 'turned down'. Glue ear usually occurs in young children, but it can develop at any age.
What causes glue ear?
The exact cause is not clear. It is probably due to the Eustachian tube not working properly. The balance of fluid and air in the middle ear may become altered if the Eustachian tube is narrow, blocked, or does not open properly. Air in the middle ear may gradually pass into the nearby cells if it is not replaced by air coming up the Eustachian tube. A vacuum may then develop in the middle ear. This may cause fluid to seep into the middle ear from the nearby cells.
Some children develop glue ear after a cough, cold, or ear infection when extra mucus is made. The mucus may build up in the middle ear and not drain well down the Eustachian tube. However, in many cases glue ear does not begin with an ear infection.
How common is glue ear?
It is common. More than 7 in 10 children have at least one episode of glue ear before they are four years old. In most cases it only lasts a short while. Boys are more commonly affected than girls. It is more common in children who:
What are the symptoms of glue ear?
Education and behaviour may
be affected if dulled hearing persists
How does glue ear progress?
The outlook is usually good. Many children only have symptoms for a short time (a few weeks or so). The fluid often drains away gradually, air returns, and hearing then returns to normal.
Some children have several episodes of glue ear which cause short but recurring bouts of reduced hearing. The total time of reduced hearing may then add up to quite a few months.
Are any tests needed?
A referral to an ear, nose, and throat (ENT) specialist may be advised at some point. This may be straight away for babies who have hearing loss. (This is to rule out other serious causes of hearing loss.) It may be after a period of 'watchful waiting' in older children who previously had good hearing. Hearing tests and ear tests can confirm the cause of hearing loss and show how bad the hearing has become.
What is the treatment for glue ear?
Watchful waiting ('wait and
Grommets normally fall out of the ear as the eardrum grows, usually after 6-12 months. By this time the glue ear has often gone away. The hole in the eardrum made for the grommet normally heals quickly when the grommet falls out. Sometimes grommets need to be put in on more than one occasion if glue ear recurs. (See a separate leaflet called 'Operations for Glue Ear'.)
In some cases, the adenoids are also taken out to improve the drainage of the Eustachian tube. Adenoids are small clumps of glandular tissue (similar to tonsils). They are attached at the back of the nose cavity near to the opening of the Eustachian tube.
What can I do for my child with glue ear?
The main thing is to be aware that your child may have dulled hearing until the condition goes away or is treated. The following are some tips.
Even after a bout of glue ear has cleared up, remember the problem may return for a while after a cold or ear infection.
Does glue ear go away?
As children grow older, problems with glue ear usually go away completely. This is probably because the Eustachian tube widens, and the drainage of the middle ear improves. In general, the older the child becomes, the less likely fluid will build up in the middle ear. Also, in older children, any fluid that does build up after a cold is likely to clear quickly. The problem has usually gone by the age of 7-8. Glue ear rarely persists in children over the age of eight.
The main concern is to make sure that your child's education does not suffer until the problem goes. In nearly all cases, once the fluid has gone, hearing returns to normal. Very rarely, persistent long-term glue ear may lead to middle ear damage and some permanent hearing loss.
Some common questions about glue ear
Can glue ear be prevented?
Are children routinely
checked for hearing?
Can medication clear glue