Otitis media with effusion (OME)
Glue ear is a common childhood condition in which 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 are 10 years old.
The main symptom of glue ear is some hearing loss in one or both ears. This usually feels similar to what you experience when you put your fingers in your ears.
Signs that your child may be having problems hearing include:
struggling to keep up with conversations
becoming aggravated because they are trying harder to hear
regularly turning up the volume on the TV
Contact your GP if you have any concerns about your child's hearing.
What causes glue ear?
The middle ear is the part of the ear directly behind the eardrum. It is made up of 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 this 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 is not caused by getting water in the ear after swimming and showering or by a build-up of ear wax.
Growing up in a household where adults smoke, being bottlefed rather than breastfed as a baby and having siblings who have had the condition are also thought to increase the risk of 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 normally 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.
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.
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
appear unusually tired or irritable because they have to try harder to listen to things
have problems picking out conversations in places where there is a lot of background noise
easily "tune out" of conversations when they are distracted
only be able to understand face-to-face conversations that take place at a short distance
experience problems with communication, learning and social skills (these problems will usually resolve once hearing is restored to normal)
Less common symptoms
Less common symptoms of glue ear include:
episodes of mild ear pain
balance problems and clumsiness
tinnitus (hearing a ringing noise in the affected ear or ears)
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 problems with their hearing.
While glue ear is usually the most common cause of hearing loss in children, further tests may be required to rule out other possible causes.
Causes of glue ear
The exact cause of glue ear is unknown, but it seems to be caused by a problem with a part of the body called the Eustachian tube.
The Eustachian tube
The Eustachian tube is a thin tube that runs from your middle ear to the back of your throat. It has two main functions:
to ventilate your middle ear, helping to maintain a normal air pressure within it –sudden changes in air pressure can be painful and can sometimes damage the ears (changes in air pressure are responsible for the popping sensation that 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. The reasons for this loss of function are still unclear, but some suggestions include:
changes in air pressure inside the ear that lead to a blockage in the Eustachian tube
inflammation of the Eustachian tube caused by allergic rhinitis, infection or irritants such as cigarette smoke, which causes 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 located 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.
While it is not known exactly what causes glue ear, several things have been identified 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 developed glue ear
having contact with lots of other children, such as at a 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 having 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 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 is used to study the inside of the ear and can detect signs that usually indicate fluid inside the middle ear.
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 tests are usually only required if your child's symptoms persist for more than three months. The tests will usually 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 movement and workings of the eardrum and the bones in the middle ear
These tests are discussed in more detail below.
Audiometry is a hearing test that uses a machine called an audiometer to produce sounds of different volume and frequency.
Your child listens to the sounds through headphones and they are asked to say when they can hear a sound and when they cannot.
An audiometry test does not cause any discomfort and most children tend to find it interesting.
Your child's ability to hear the different sounds can be seen on a chart called an audiogram.
Tympanometry is a test that measures how the ear drum reacts to changes in air pressure. A healthy ear drum should move easily if there is a change in air pressure. If your child's ear drum moves slowly or not at all, it usually suggests that there is fluid behind it.
During a tympanometry test, a probe is placed into your child's ear. The probe changes the air pressure at regular intervals while transmitting a sound into the ear.
A measuring device is attached to the probe to record how the sound reflects back from the ear and how changes in air pressure affect these measurements.
If less sound is reflected back when the air pressure inside the ear is high, it usually indicates that the ear drum is having problems moving because of fluid.
Treating glue ear
For the first three months after glue ear has been diagnosed, it's likely your child will receive no treatment but their condition will be monitored by your GP.
This is known as "active observation".
This is because more than half of all cases of glue ear resolve within three months and there is currently no medication that shortens the length of time the symptoms last.
Medications such as antihistamines, decongestants andantibiotics 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:
severe hearing loss
hearing loss causing significant problems with their learning, development and social skills
Down's syndrome or a cleft palate
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 difficulties worse.
In these circumstances you will likely be referred to your local ear, nose and throat (ENT) department for further assessment and treatment.
The two main treatment options for glue ear are hearing aids and grommets (a grommet is a very small tube that is inserted into your child's ear during surgery).
Hearing aids are often recommended for children with Down's syndrome as surgery can have unpredictable results.
Hearing aids can also be used when your child is unable to have surgery or you are 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.
A grommet is a very small tube that is inserted into your child's ear through a small cut in their eardrum. Grommets can help drain away fluid in the middle ear and maintain air pressure.
Grommets are inserted during an operation called a grommet insertion. This procedure is carried out under general anaesthetic(where your child is asleep and doesn't feel any pain). It usually only 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 are 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 should not be painful. Most grommets will fall out within 6-12 months of being inserted. Around one child in three will need further grommets.
Although grommet insertion is generally a simple and safe procedure, as with all types of surgery there is a risk of complications. These include developing an ear infection or a small hole in the ear drum (perforated ear drum).
Watch an animation showing how grommet insertion surgery is performed.
There are a number of less commonly used treatments for glue ear.
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 is not always suitable.
If it causes your child pain, you should stop this treatment. Autoinflation should also not be carried out if your child has a cold, chest infection, throat infection or flu.
An adenoidectomy is the surgical removal of the adenoids.
The adenoids are soft mounds of tissue at the very back of the throat. They are part of the body's immune system, which helps to fight infection.
If your child's adenoids are enlarged and swollen, they can sometimes block the Eustachian tube. Having them removed can help the Eustachian tube work better.
The procedure is carried out under general anaesthetic and your child will usually be able to go home the same day. An adenoidectomy is often performed at the same time as a grommet insertion.
As with grommet insertion, an adenoidectomy is a relatively simple procedure and the risk of complications is low. However, there is a small chance of problems such as bleeding and infection.
Complications of glue ear
There are a number of complications your child may develop as a result of having glue ear or having 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 only 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. They found no significant differences when compared with other children of the same age.
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:
crying more than usual
having a high temperature (fever) of 38ºC (100.4ºF) 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.
Thickening of the eardrum
Slight thickening of the eardrum tissue, known as tympanosclerosis, is a common complication in children who had their glue ear treated with grommets. It occurs in around one in four cases.
It is uncertain whether the thickening of the ear drum is caused by the grommets, glue ear itself, or a combination of the two.
Normally, the thickening of the ear drum is so small that there are no noticeable symptoms. Very rarely, tympanosclerosis is severe enough to cause a hearing loss. 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 is not common in the majority of children, who only require one set of grommets.
If glue ear is complicated by infection, there is 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.
Preventing glue ear
As the cause of glue ear isn't fully understood, there is no known way of preventing it.
However, there are steps that can be taken to reduce two of the known risk factors for children. These include:
breastfeeding your baby rather than bottlefeeding
making sure your child isn't raised in a smoky environment and avoiding close contact with people who smoke (passive smoking)
It is unclear why passive smoking increases the risk of developing glue ear. It may be that the smoke irritates the lining of the Eustachian tube (the tube linking the middle ear with the back of the throat), causing it to become inflamed.
Not smoking around your children also has many other important health benefits, including:
reducing the risk of developing asthma
reducing the risk of developing a chronic lung condition in adulthood
reducing the risk of dying from sudden infant death syndrome (SIDS), also known as cot death
If you smoke, always try to smoke outside your house. Smoking in another room can still affect your children's health because the smoke can easily travel from one room to another, and the toxic chemicals in tobacco smoke can stay in the air for several hours.
If you decide to stop smoking, your GP will be able to refer you to an Smokefree service, which will provide you with dedicated help and advice about the best ways to give up smoking.
You can also call the Smoking Helpline on 0800 022 4 332 (Monday to Friday 9am to 8pm, weekends 11am to 4pm). The specially trained helpline staff will be able to offer you free expert advice and encouragement.
As with passive smoking, it is uncertain why breastfeeding reduces the risk of glue ear. One theory is that breast milk contains proteins that help reduce inflammation inside the Eustachian tube.