Glue ear

Why does glue ear happen?

The ear has three main parts ear canal, the middle ear where small bones of hearing sit and the inner ear which has nerves to send the signal to the brain.

The middle ear is connected to the back of the nose with a tube called the Eustachian tube. The Eustachian tube can get blocked with adenoids, allergy or sometimes due to tube dysfunction. The Eustachian tube can also dysfunction in children with a cleft palate or a genetic condition such as downs syndrome. All this can lead to a collection of thick fluid in the middle ear, and this is called glue ear.

Glue ear in babies?

Babies have smaller and straighter eustachian tube making them more vulnerable to glue ears. The good news is this is intermittent most of the time. Breastfeeding in a sitting position helps and also passes on natural immunity from mother to children. Evidence show children growing up in a smoky environment tend to get more frequent glue ear. Children who have an allergy to pets, house dust mites or pollens can get glue ears. It is crucial to check allergy and treat it in such children.

How does glue ear affect a child's development?
Persistent Glue ear can have a direct and indirect impact on a child's behaviour and speech-language development. The direct impact is as a child is unable to hear words clearly it affects vocabulary development and leads to limited attention span. It can also affect the balance in younger children. Persistent glue can have a direct impact on school performance and affect sleep due to a recurrent earaches. The rate of ear infections is higher in children with glue ears. Long-term impact due to persistent glue ear and eustachian tube dysfunction can lead to eardrum retraction, ossicular (small bones of hearing) erosion, eardrum perforation, and cholesteatoma formation.

Can Glue ear mimic Autism and ADHD?
Autism spectrum disorder presents before the age of three when a child has difficulty in communication, interaction, and interests. Glue ear is looked for as part of the investigation and diagnosis. Glue ear can affect a child's hearing, and a child may lose interest in interacting and communicating with carers. Treating hearing problems may support the team looking after such special children. ASD is treated with a multidisciplinary approach focusing on a child's communication skills, social interaction skills, and academic skills.
https://www.autism.org.uk/

How can I prevent glue ear?
Glue ears are more common in children who suffer from allergies, adenoids or live in a house with smoke. Things you can do to help are breastfeeding newborns, bottle feeding in propped-up position and keeping the house smoke-free.

How can I pick up if my child has a Glue ear?
Generally, the first symptom is hearing impairment. Babies may not respond when called and older children may ask you to repeat things. You may notice that the child is keeping TV volume unusually high. Older children may lose their concentration and focus. Some children may start complaining of ear pain and may start having ear infections.

What is the natural history of Glue ear?
50% of the cases of glue ear will resolve in three months. Once the glue ear resolves hearing should go back to normal. Children with persistent glue ears may start to have an impact on speech and development. Such kids need to be reviewed by specialists and management advice taken.

What can be done once we identify Glue ear in a Child?
Working together with parents, schools, and ENT specialists we all can help a child with glue ear. Parents should understand in most cases the condition is temporary. It is important to talk to a child facing them, at a slow pace and without any background noise. Informing the nursery or school regarding the child's condition. School can help a child with teachers facing the child and the child sitting close to the teacher during lessons.

How is the diagnosis of glue ear made?
In children on suspicion of glue ear, they can be referred to Ear Nose Throat specialist for assessment and organizing the age-appropriate hearing test.
A special test called a tympanogram is done to support the clinical findings, and in most cases, watchful waiting is commenced. If a child has persistent glue ear, then treatment options include watchful wait, balloon treatment hearing aid or grommet insertion.

Can Balloon treatment help with Glue ear?
Balloon treatment also known as auto inflation can be tried in children from the age of 3. Auto inflation works on the principle of increasing air pressure at the back of the nose to open the eustachian tube. NICE recommends the use of Balloon auto-inflation during watchful waiting. Balloon auto-inflation is available commercially and on prescription from Otovent. https://www.otovent.co.uk/

Can my child have a hearing aid for glue ear?
Hearing aids can support a child with glue ear during the wait and watch period. If the child has a genetic condition like Down's syndrome, then a hearing aid may be recommended as compared to grommets. Few considerations to remember like sports activity, school and the use of batteries.
https://www.ndcs.org.uk/hearingaidsFAQS#contentblock12

Mr Gaurav Kumar

Ear Nose Throat Consultant

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Disclaimer: For general information only, always seek medical advice from your treating consultant.

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