Paediatric Audiology Service Glue ear in children
Information for parents and carers This booklet has been provided to help answer some of the questions you may have about glue ear in children. What is glue ear? In a normal ear, sound waves produce vibrations of the eardrum, and are transmitted to the inner ear by a series of three bones (the Ossicular Chain). The inner ear converts these vibrations into electrical impulses which travel along the nerves to the brain. The three small bones lie in the middle ear, which normally contains air. Air enters the middle ear through a narrow tube (the Eustachian tube) which connects to the back of the nose near the adenoids. Adenoids are made of glandular tissue and are part of the immune system. They hang from the upper part of the back of the nasal cavity. Sometimes the Eustachian tube does not work correctly and fluid (glue) collects in the middle ear. This is glue ear. The fluid stops your child’s eardrum and the three little bones from moving freely and this can affect hearing. Any hearing loss is usually temporary. Is glue ear a common condition? Yes, four out of five children will have experienced glue ear before they are four years old. However, not all children with glue ear have difficulty hearing. What does glue ear look like? The fluid behind the eardrum varies from thin and runny to thick and sticky. It usually gives the ear drum a dull appearance and can affect the hearing to varying degrees. This condition will often get better by itself once the Eustachian tube is no longer blocked. Around half of cases recover without treatment in about three months. Glue ear can recur, but most children outgrow it by the time they are about eight years old. What causes glue ear? The Eustachian tube is narrow in children and easily becomes blocked. You may find that it is triggered by a cold. Children with large adenoids, or children subjected to passive smoking, can be prone to repeated episodes of glue ear. What treatment is available for glue ear? Many cases of glue ear will get better without treatment within about three to four months. For this reason, glue ear treatment is not recommended unless your child has a hearing loss which lasts longer than three months. If the condition does not improve on its own, then the following options are available: (i) Continued watchful waiting Provided that your child does not seem to be suffering as a result of the glue ear, it is reasonable to continue waiting to see if they grow out of it without any intervention. This is most appropriate in cases where the glue ear is not causing a significant hearing loss in both ears. We will usually check your child’s hearing every three to six months. In the majority of cases, the glue ear eventually gets better on its own. If the condition does not improve, we may refer your child to the Ear, Nose and Throat (ENT) department to check the health of their ears. During this waiting period, your doctor may prescribe an Otovent which is a device your child can use try to clear the fluid. (ii) Surgery Surgery is considered after three months if the glue ear is affecting your child’s hearing or speech progress. There are two common operations for glue ear: Grommet insertion – This involves inserting a very small plastic tube through the eardrum which allows air into the middle ear. Grommets usually fall out after around 6 to 12 months allowing the eardrum to heal over. Adenoidectomy ‐ This is where we remove the adenoid tissue which often improves the drainage of the middle ear by the Eustachian tube. Unfortunately glue ear can come back once the grommets have fallen out. If the glue ear does keep returning, repeated surgery may not be appropriate. (iii) Hearing aids We will consider hearing aids after three months if the glue ear is affecting your child’s hearing and surgery is not recommended. Hearing aids may be the preferred option in young children, or those children who have tried grommets in the past. As glue ear tends to cause a hearing loss which varies over time your child will need to attend appointments every three to six months to have their hearing measured and their aid(s) adjusted. What signs should I look out for? The following signs could indicate that glue ear is affecting your child:  Having to raise your voice for your child to hear you  Their speech is not developing normally  Your child is behaving in a way that could be due to hearing difficulties. For example, they may seem frustrated (throwing temper tantrums) or withdrawn. Is there a medicine I can use? Lots of medications have been tried to treat glue ear but they have not proved to be helpful. We can advise you how to manage this condition. Should I let the school know? Yes! Tell the school, nursery or any other carer about your child’s diagnosis. They will ensure that your child sits at the front of the class. All teachers in school and any other adults looking after your child should be aware of the problem. This is important for the safety of your child. What can I do to help my child? Make sure you have your child’s attention before you speak and do not speak from behind him/ her. Speak clearly and loudly asking your child to repeat back instructions to you. There is no need to shout! Try to reduce any background noise (such as the television) when talking to your child. Further information National Deaf Children’s Society Helpline: 0808 800 8880 www.ndcs.org.uk Deafness Research UK Helpline: 0808 808 2222 www.deafnessresearch.org.uk ENT UK www.entuk.org Contact details Winchester: Paediatric Audiology Department Royal Hampshire County Hospital. Telephone: 01962 825775 Basingstoke: Telephone Dr Sharon Doyle 07785 458103 or ENT department 01256 313553 www.hampshirehospitals.nhs.uk Paediatric Audiology Department, HHFT March, 2013 Review March, 2014 SS/ 024/ 2013 © Hampshire Hospitals NHS Foundation Trust