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Published by Bupa's health information team, December 2009.
This factsheet is for parents of children with glue ear, or who would like information about it.
Glue ear is very common in children - approximately four out of five children will have had the condition at least once by the time they are four years old. The medical name for glue ear is otitis media with effusion. If a child has glue ear, it means there is a build-up of fluid in the middle ear, which can affect his or her hearing. Some children may need surgery to help clear the ear.
How glue ear develops
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The middle ear
The middle ear is behind your eardrum. It contains three tiny bones that move when sounds reach them. These transmit sound waves through your middle ear to your inner ear. Usually, your middle ear is filled with air but if you have inflammation, fluid and mucus can build up there. The eustachian tube connects your middle ear with your throat.
The outer, middle and inner ear
About glue ear
Glue ear occurs when fluid and mucus collect in the middle ear behind the ear drum. This often happens after a middle ear infection or other condition that causes inflammation there.
Your child can get glue ear if the eustachian tube becomes blocked and fluid can't drain from the middle ear. A blocked eustachian tube can also stop air from getting into the middle ear. The air that is trapped in the middle ear is absorbed, reducing the pressure inside your child's ear and pulling the eardrum inwards. A sticky fluid builds up inside the middle ear and affects hearing, since the middle ear is filled with liquid rather than air.
Symptoms of glue ear
Unlike a middle ear infection (acute otitis media) where there is often earache, a high temperature and other signs of illness, with glue ear your child won't necessarily complain of any symptoms. The main problem is hearing loss and a feeling of the ear being "bunged up". This can come on gradually and therefore your child may not notice. The hearing loss is similar to wearing earplugs.
As a result of this hearing impairment, your child may have problems paying attention or interacting with others, as well as with his or her speech and language. Your child may also appear clumsy and have trouble with balance.
Causes of glue ear
Children under six are most at risk of glue ear because their eustachian tubes are shorter and more horizontal. This means that they get blocked more easily. Boys tend to be affected more than girls and the condition is more common in winter than summer.
Over half of all children with glue ear get it as a result of a bout of inflammation of the middle ear (acute otitis media).
If your child has nasal allergies to pets or dust, or has hay fever, he or she may be more likely to develop glue ear. Inflammation caused by the allergic reaction may cause their eustachian tube to swell and become blocked more easily. This may be the cause of glue ear if your child keeps getting it, even after he or she has had treatment.
Glue ear may also be caused by enlarged adenoids - these are two lumps of tissue at the back of the nose where it meets the throat. Adenoids help to fight infections but if your child's are enlarged, they can block the eustachian tube.
Other reasons why your child may be more likely to develop glue ear include:
- smoking in the house or in the car that is used to transport him or her
- repeated colds and throat infections
- having brothers or sisters with glue ear
Your child is also at an increased risk if he or she has a lot of contact with other children, for example at a nursery or playschool. In addition, children who are born with a cleft lip or palate, or who have Down's syndrome are more likely to get middle ear infections and so are more susceptible to glue ear.
Diagnosis of glue ear
Your GP will ask about your child's symptoms and medical history. He or she will use an instrument called an otoscope to look at your child's eardrum.
For most children, glue ear doesn't become long-term problem. At least half of children with glue ear get better within three months and only one in 20 are affected for longer than a year.
A child who has persistent glue ear or repeated bouts of it may need to be monitored to make sure his or her hearing and language isn't affected. After your child has a bout of glue ear, your GP may suggest you bring him or her back in two to three months for a check-up. The doctor may ask for extra information from the school (if relevant) and refer you to a speech and language therapist.
Treatment of glue ear
After three months of monitoring, if the condition isn't improving, your GP may suggest that your child has a hearing test. He or she may refer your child to an otolaryngologist (a doctor specialising in conditions affecting the ear, nose and throat) or an audiological paediatrician (a doctor specialising in conditions affecting children's hearing). Your GP may also refer your child to a specialist if there is a persistent foul-smelling discharge from the ear, severe hearing loss or if he or she has a disability such as Down's syndrome.
Antibiotics, antihistamines and decongestants aren't recommended for glue ear. There is a possibility that your child may have side-effects to antibiotics. There is also no evidence that homeopathy, cranial osteopathy or special diets help with glue ear.
Once your GP has diagnosed persistent glue ear, it's important that your child has regular hearing checks. A hearing aid may be useful if surgery isn't acceptable.
There is some evidence that a technique called autoinflation may help children with glue ear. Your child uses his or her nose to inflate a special balloon (called an Otovent, which can be bought from some pharmacies). This increases pressure in the nose and may help to open up the eustachian tube. This aims to let air into the middle ear so the fluid there can drain out. Some studies have shown this technique to be helpful in the short term, but more research is needed into the long-term effects.
Your GP will be able to give you more information about the treatment options that are available.
After carefully monitoring your child's condition for three to six months, your doctor may suggest surgery. Surgery is recommended for children who have severe hearing loss.
Surgery may involve a procedure called a myringotomy in which a small cut is made in your child's ear drum so that fluid can drain out. Ventilation tubes called grommets or tympanostomy tubes may also be inserted into your child's ear. These are small plastic tubes which are placed in a cut made in your child's eardrum. Grommets allow air to get in and out of the ear. They can be effective at improving hearing for up to two years but don't appear to offer any benefit in the long term. Grommets usually fall out after about six months to a year. Half of all children who have grommets inserted need to have another set put in after the first ones fall out.
If your child has grommets, it's fine to go swimming although diving and putting his or her head underwater (even in the bath) isn't recommended.
It may help your child to have an operation to remove his or her adenoids. This is called an adenoidectomy. However, the operation alone doesn't seem to improve hearing unless grommets are also inserted.
As with all surgery, there are some risks involved with inserting grommets or having an adenoidectomy. These include infection or, with grommets, the possibility of permanent damage to your child's eardrum. Discuss the risks with your child's surgeon.
Glue ear Q&As
See our answers to common questions about glue ear, including:
National Deaf Children's Society
0808 800 8880
Deafness Research UK
0808 808 2222
- Diagnosis and management of childhood otitis media in primary care. Section 1: Introduction. Scottish Intercollegiate Guidelines Network (SIGN). www.sign.ac.uk, accessed 5 September 2009
- Otitis media with effusion. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 5 September 2009
- Moore K, Dalley A. Clinically oriented anatomy. 4th ed. Philadelphia: Lippincott Williams and Wilkins, 1999
- Glue ear. British Association of Otorhinolaryngologists - Head and Neck Surgeons. www.entuk.org, accessed 5 September 2009
- Toivonen M , Paakkonen R , Savolainen S, et al. Noise attenuation and proper insertion of earplugs into ear canals. Ann Occup Hyg 2002; 46:527-530
- Williamson I. OME in children. Clinical Evidence. www.clinicalevidence.bmj.com, accessed 5 September 2009
- Surgical management of otitis media with effusion in children. National Institute for Health and Clinical Excellence. www.nice.org.uk, accessed 5 September 2009
- Perera R, Haynes J, Glasziou PP, et al. Autoinflation for hearing loss associated with otitis media with effusion. Cochrane Database of Systematic Reviews 2006, Issue 4. DOI: 10.1002/14651858.CD006285
- Williamson I, Little P. Otitis media with effusion: the long and winding road? Arch Dis Child 2008; 93:268
- Simon C, Everitt H, Kendrick T. Oxford handbook of general practice. 2nd ed. Oxford: Oxford University Press, 2006:926
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: December 2009