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Glue ear Content Supplied by NHS Choices
Introduction

Glue ear is a common childhood condition where the middle ear becomes filled with fluid. The medical term for glue ear is otitis media with effusion (OME).

It's estimated that one in five children around the age of two will be affected by glue ear at any given time, and about 8 in every 10 children will have had glue ear at least once by the time they're 10 years old.

The main symptom of glue ear is some hearing loss in one or both ears. This is usually similar to what you experience when you put your hands over your ears.

Signs that your child may be having problems hearing include:

  • struggling to keep up with conversations
  • becoming aggravated because they're trying harder to hear
  • regularly turning up the volume on the television

Contact your GP if you have any concerns about your child's hearing.

Read more about the symptoms of glue ear and diagnosing glue ear.

What causes glue ear

The middle ear is the part of the ear directly behind the eardrum. It contains three tiny bones that carry sound vibrations from the eardrum to the inner ear. The build-up of fluid associated with glue ear prevents these bones moving freely, which affects hearing because it means they can't pass sound vibrations to the inner ear.

Exactly what causes this build-up of fluid is unclear, although it seems to be related to a problem with the tube that connects the middle ear to the back of the throat (Eustachian tube). One of the main functions of the Eustachian tube is to help drain fluid from the middle ear.

It's thought that problems with the Eustachian tube may be caused by things like a previous ear infection, smoke irritation or allergies. Glue ear isn't caused by a build-up of ear wax, or by getting water in the ear after swimming or showering.

Other factors that are also thought to increase the risk of getting glue ear include:

  • growing up in a household where adults smoke
  • being bottlefed rather than breastfed as a baby
  • having siblings (brothers and sisters) who've had the condition

Read more about the causes of glue ear and preventing glue ear.

Treating glue ear

Most cases of glue ear don't require treatment as the condition will improve by itself, usually within three months.

Treatment is usually only recommended when symptoms last longer than three months and the hearing loss is thought to be significant enough to interfere with a child's speech and language development.

In these circumstances, glue ear can usually be treated using minor surgery, which involves placing small tubes (grommets) in the ear to help drain away the fluid.

Read more about treating glue ear.

Complications of glue ear

Possible complications of glue ear include ear infections and, where hearing loss is more severe, a minor temporary delay in speech and language development.

Some of the problems associated with glue ear get better by themselves quite quickly, although further treatment may occasionally be necessary.

Read more about the complications of glue ear.


Symptoms of glue ear

The most common sign of glue ear is hearing loss, which can affect one or both ears.

If your child is struggling to hear, they may:

  • have difficulty understanding people who are far away
  • speak quietly
  • appear unusually tired or irritable, because they have to try harder to listen to things
  • have problems picking out conversations in places where there's a lot of background noise
  • easily "tune out" of conversations when they're distracted
  • only be able to understand face-to-face conversations that take place at a short distance
  • experience problems with communication and learning, and social skills (these problems will usually resolve once normal hearing is restored)

Read more about the symptoms of hearing loss.

Less common symptoms

Less common symptoms of glue ear include:

  • episodes of mild ear pain
  • irritability
  • problems sleeping
  • balance problems and clumsiness
  • tinnitus
  • delayed speech and language development in younger children, if the condition lasts a long time

When to seek medical advice

It's important to see your GP if you're concerned that your child may be having hearing problems.

While glue ear is usually the most common cause of hearing loss in children, further tests may be needed to rule out other possible causes.

Read more about diagnosing glue ear.

Causes of glue ear

The exact cause of glue ear is unknown, but it seems to be caused by a problem with the Eustachian tube.

The Eustachian tube

The Eustachian tube is a narrow tube that runs from your middle ear to the back of your throat. Its two main functions are:

  • to ventilate your middle ear, helping to maintain a normal air pressure within it - sudden changes in air pressure can be painful and can damage the ears (changes in air pressure can cause the popping sensation many people experience on an aeroplane)
  • to help drain away mucus and other debris from the ear - the middle ear can often become clogged with mucus caused by inflammation, infection or an allergic reaction

With glue ear, the Eustachian tube seems to lose the ability to drain away the mucus. The mucus builds up inside the ear, which leads to glue ear. Why this loss of function occurs is still unclear, but some suggestions include:

  • changes in air pressure inside the ear, which causes a blockage in the Eustachian tube
  • inflammation of the Eustachian tube caused by allergic rhinitis, infection or irritants such as cigarette smoke, which cause the tube to narrow
  • gastric fluids from the stomach that leak up through the throat and into the Eustachian tube
  • inflammation and swelling of the adenoid glands (small lumps of tissue at the back of the throat that form part of a child's immune system)

Children are more susceptible to problems like these because the Eustachian tube is smaller and more horizontal during childhood, which means it can't drain as effectively as it can in adults. As the Eustachian tube develops with age, glue ear becomes much less common.

Increased risk

The exact cause of glue ear is unknown, but there are several factors that may increase the risk of children developing the condition. These include:

  • living in a house where the parents smoke
  • being bottlefed rather than breastfed
  • having a brother or sister who also had glue ear
  • having contact with other children, such as at nursery (this may be because of a higher risk of infection)
  • having a cleft palate (a type of birth defect, where a child has a split in the roof of their mouth)
  • having allergic rhinitis (an allergic condition that causes cold-like symptoms, such as a runny nose and sneezing)
  • having Down's syndrome (a genetic disorder that causes learning difficulties and disrupts physical development)
  • having cystic fibrosis (a genetic condition that causes the lungs to clog up with thick, sticky mucus)
Diagnosing glue ear

A diagnosis of glue ear can usually be confirmed by using an instrument called an otoscope.

An otoscope is a small hand-held device that has a magnifying glass and a light source at the end. It's used to study the inside of the ear and can detect signs that usually indicate fluid inside the middle ear.

These include:

  • the ear drum being pulled inwards
  • the ear drum being an unusual colour
  • the ear drum having a cloudy appearance
  • bubbles and fluid inside the ear

Further testing

Further tests are usually only required if your child's symptoms persist for more than three months. The tests will often be carried out at your local ear, nose and throat (ENT) department and include:

  • audiometry - to assess the extent of your child's hearing loss
  • tympanometry - to assess the flexibility of the eardrum and the bones in the middle ear

These tests are discussed in more detail below.

Audiometry

Audiometry is a hearing test that uses a machine called an audiometer to generate sounds of different volumes and frequencies.

Your child will listen to the sounds through headphones and will be asked to respond when they hear them - for example, by pressing a button.

By decreasing the sound level, the tester can work out the quietest sounds that your child can hear. Your child's ability to hear the different sounds can be seen on a chart called an audiogram.

Audiometry doesn't cause any discomfort and most children find it interesting.

Tympanometry

Tympanometry is a test to determine how flexible the eardrum is. For good hearing, your eardrum needs to be flexible to allow sound to pass through it.

If the eardrum is too rigid - for example, because there's fluid behind it - sounds will bounce back off the eardrum, instead of passing through it.

During the test, a small tube with a soft rubber tip will be placed at the entrance of your child's ear and air will be gently blown down it. The tube measures the sound that's bounced back from the ear.

If most of the sound is bounced back, it will indicate to the tester that your child's eardrum is rigid and that they may have glue ear.

Treating glue ear

For the first three months after glue ear is diagnosed, it's likely that your child won't receive any treatment.

However, your child's condition will be monitored by your GP. This is known as "active observation" or "watchful waiting".

Treatment for glue ear isn't usually given during the first three months after diagnosis, because over half of all cases resolve within three months, and there's no medication that shortens the length of time the symptoms last.

Medications such as antihistamines, decongestants and antibiotics have been tested for treating glue ear, but evidence shows they have little effect in shortening the duration of symptoms. They can also cause side effects.

When treatment is required

If your child still has fluid in their ear(s) after three months, active observation may still continue. This is because 9 out of 10 cases of glue ear resolve within a year.

Treatment is usually only recommended if your child has:

Glue ear is unlikely to get better by itself in children with Down's syndrome or a cleft palate, and hearing loss could make existing communication problems worse.

In these circumstances, you will probably be referred to your local ear, nose and throat (ENT) department for further assessment and treatment.

Hearing aids and grommets are the two main treatment options for glue ear.

The various treatments for glue ear are outlined below. You can also read a summary of the pros and cons of the treatments for glue ear, allowing you to compare your treatment options.

Hearing aids

Hearing aids are often recommended for children with Down's syndrome, because surgery can have unpredictable results.

Hearing aids can also be used when your child is unable to have surgery or you're unwilling for surgery to be carried out.

A hearing aid is an electronic device that consists of a microphone, amplifier, loudspeaker and battery.

Modern hearing aids are very small and discreet, and some can be worn inside the ear. The microphone picks up sound, which is made louder by the amplifier.

Hearing aids are also fitted with devices that can distinguish between background noise, such as traffic, and foreground noise, such as conversation.

Grommets

A grommet is a very small tube that's inserted into your child's ear during surgery. It can help drain away fluid in the middle ear and maintain air pressure.

Grommets are inserted during an operation called a grommet insertion. The procedure is carried out under general anaesthetic (your child will be unconscious and won't feel any pain). The procedure takes about 15 minutes, so your child should be able to go home the same day.

During the first few days after surgery, your child may find that noises sound much louder than they're used to. This is normal and should pass as your child gets used to having a normal level of hearing.

A grommet will help keep the eardrum open for several months. As the eardrum starts to heal, the grommet will slowly be pushed out of the eardrum and will eventually fall out. This process happens naturally and shouldn't be painful. Most grommets will fall out within 6-12 months of being inserted. Around 1 child in 3 will need further grommets.

Grommet insertion is generally a simple and safe procedure, but as with all types of surgery, there's a risk of complications. These include developing an ear infection or a small hole in the ear drum (perforated ear drum).

See complications of glue ear for more information.

You can also watch the animation above that shows how grommets are inserted.

Other treatments

There are a number of less commonly used treatments for glue ear, which are listed below.

Autoinflation

Autoinflation involves your child blowing up a special balloon using their nose. It helps to open up the Eustachian tube, making it easier for the tube to drain fluid from the middle ear.

This will need to be done regularly, until all the fluid has drained away. Autoinflation can be difficult for young children to do and isn't always suitable.

If autoinflation causes your child pain, treatment should be stopped. Autoinflation should also not be carried out if your child has a cold, chest infection, throat infection or flu.

Adenoidectomy

An adenoidectomy is a surgical procedure to remove the adenoids. The adenoids are small, soft glands at the very back of the nose. They help to detect germs and notify the immune system. It's thought that after around the age of three, the adenoids aren't needed any more, because the body is able to fight germs without them.

The adenoids are usually only removed if they're causing problems. For example, if your child's adenoids are swollen and enlarged, they can sometimes block the Eustachian tube. Removing them can help the Eustachian tube to work better.

An adenoidectomy is carried out under general anaesthetic and your child will usually be able to go home the same day. The procedure is often carried out at the same time as a grommet insertion or removal of the tonsils (tonsillectomy).

As with grommet insertion, an adenoidectomy is a relatively simple procedure and the risk of complications is very low. However, there's a small chance of problems, such as bleeding and infection.

Read more about the risks of an adenoidectomy.

Complications of glue ear

There are a number of complications your child may develop as a result of having glue ear or surgery to treat the condition.

Many of these problems can either be treated or they improve quickly on their own.

Delayed speech and language development

Children with glue ear may experience some delay in their speech and language development, particularly if their loss of hearing is prolonged and occurs before the age of three.

However, in most cases, the delay is temporary and children usually catch up with their peers once their hearing returns to normal.

One study looked at how children with an early history of glue ear performed at school. No significant differences were found when they were compared with other children of the same age.

Ear infection

An acute middle ear infection (otitis media) is a common complication of glue ear. It develops when bacteria infects the fluid inside the middle ear.

Symptoms of otitis media in children include:

  • ear pain
  • crying more than usual
  • problems sleeping
  • having a high temperature (fever) of 38C (100.4F) or above
  • a discharge of fluid or pus from the ear

About four out of five cases of otitis media will pass within two to three days, without the need for treatment. Antibiotics can be used if symptoms are particularly severe.

Read more about treating otitis media.

Thickening of the eardrum

Slight thickening of the eardrum tissue, known as tympanosclerosis, is a common complication in children who have had glue ear treated with grommets. It occurs in around one in four cases.

It's not known whether the thickening of the ear drum is caused by the grommets, glue ear itself, or a combination of the two.

The thickening of the ear drum is usually so small that there are no noticeable symptoms. Very rarely, tympanosclerosis is severe enough to cause a loss of hearing. This is mostly seen in the small number of people with recurring glue ear and ear infections, and those who have had surgery more than once. It's not common in the majority of children, who only require one set of grommets.

Perforated eardrum

If glue ear is complicated by infection, there's a small risk that pus can form inside the middle ear. The pus can put pressure on the ear, causing a hole (perforation) to develop in the eardrum, which can lead to some loss of hearing. In most cases, the eardrum heals by itself within six to eight weeks.

A persistent perforated eardrum is an uncommon complication of glue ear, occurring in an estimated 1 in every 100 cases. In these cases, the perforated eardrum can be treated using a type of minor surgery called myringoplasty, where tissue is used to seal the hole in the eardrum.

Read more about treating a perforated eardrum.

Preventing glue ear

As the cause of glue ear isn't fully understood, there's no known way of preventing it.

However, research has shown that the risk of babies and young children developing glue ear can be reduced by:

  • breastfeeding your baby, rather than bottle feeding them
  • bringing your child up in a smoke-free environment, which includes making sure your child avoids close contact with people who smoke (passive smoking)

Breastfeeding

The exact reason why breastfeeding reduces the risk of glue ear is unknown, but it's thought that breast milk contains proteins that help reduce inflammation inside the Eustachian tube.

Read more about the benefits of breastfeeding.

Passive smoking

Research has shown that a child's risk of getting glue ear is increased if they're often in a smoky environment. It's recommended that a child's environment is smoke-free, both inside and outside the home.

Not smoking is the best way to protect your child. However, if you smoke, always try to smoke outside. Smoking in another room can still affect your child's health, because smoke travels easily from one room to another, and the toxic chemicals produced can stay in the air for several hours.

Not smoking around your children also has many other important health benefits for your children. For example, it reduces their risk of:

If you decide to stop smoking, your GP can refer you to an NHS Smokefree service, which can provide help and advice about the best ways to give up.

You can also call the free NHS Smoking Helpline on 0300 123 1044 (Monday to Friday 9am to 8pm, weekends 11am to 4pm). Specially trained helpline staff can offer free expert advice and encouragement.

Read more about stop smoking treatments.

 
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