Glue ear

Glue ear is when sticky fluid builds up behind the ear drum. The main symptom is difficulty hearing and most commonly occurs in infants. Glue ear usually resolves on its own but treatment should be sought if it lasts for 3 months or longer.

Glue ear (known medically as otitis media with effusion, or OME) occurs when a thick or sticky glue-like fluid builds up in the middle ear, which is the space behind the ear drum that normally contains air. Glue ear can affect one or both ears. It is most common in children but can also occur in adults. Glue ear is not an infection but often follows an ear infection.

Children with glue ear often have difficulty hearing. Hearing loss over a long period during early life can result in slower development of a child’s speech and language skills. When communicating with a child with glue ear, it helps to speak slowly and clearly to them, and for them to be able to see your face when you are speaking to them. It may also help to tell school teachers that a child has glue ear so that the teacher knows to get the child’s attention before speaking to them and have them at the front of the class.

Causes

The eustachian tube runs from the middle ear to the back of the throat. One of its functions is to drain fluid that is produced in the middle ear. The fluid can build up if the eustachian tube becomes blocked, which can lead to glue ear. Because the eustachian tube is narrow in infants and young children, it is more prone to blockage than in older children, teenagers, and adults.

Anything that causes the eustachian tube to become swollen or blocked can result in fluid build-up in the middle ear. Some of these causes include the following:

• Allergies
• A cold or sinusitis 
• Blocked nose
• Swollen tonsils (adenoids)
• Excessive mucus and saliva produced during teething
• Tonsillitis
• Tobacco smoke
• Drinking while lying back.

Signs and symptoms

The main symptom of glue ear is difficulty hearing. Unlike ear infection, children with glue ear do not appear to be obviously sick or unwell. The condition is usually painless and infants and young children with glue ear may not be able to communicate their hearing loss. Consequently, glue ear is often missed in children.

The following may indicate that a child has glue ear:

• Loss of interest in sounds
• Not listening to instructions or engaging (which can be misinterpreted as naughtiness)
• Asking for things to be said again
• Irritability due to missing out on what others are saying
• Turning up the volume of the TV or other electronic gadgets
• Disturbed sleep
• Problems with speech and language development.

Older children and adults with glue ear often complain of muffled hearing or a sense of fullness in the ear.

If you think your child has glue ear or you are concerned about their hearing or language development you should take them to your GP.

Diagnosis

Glue ear is diagnosed after taking a medical history and examination of a child’s ears using an instrument that allows a doctor to look closely at the ear canal and ear drum.

An instrument that measures how well the ear drum moves back and forth may also be used. If there is fluid in the middle ear, the ear drum does not move.

Sometimes a hearing test may be recommended.

Treatment

Glue ear usually gets better on its own but this can take weeks or months. As children grow their eustachian tubes get larger and become more efficient in draining fluid from the middle ear, hence preventing the build-up of fluid.

Most GPs will not treat glue ear at first, unless there are also signs of an ear infection. Instead, they will re-check the problem in 2 to 3 months. If glue ear lasts longer than 3 months, treatment may be required, which is usually either regular check-ups or grommets.

Regular check-ups

If your child’s hearing and speech development are normal, your GP may simply recommend regular follow-up appointments to check their ears since the likelihood of glue ear lessens as children grow older.

Grommets

Children who get glue ear often or if their glue ear lasts longer than 3 months may benefit from the fitting of grommets. Grommets are tiny plastic ventilation tubes that are inserted in the ear drum to let air access the middle ear, which reduces the risk of fluid building up.

Grommets are a temporary measure that allow time for the eustachian tubes to mature and become fully functional. Grommets usually fall out of the ear by themselves after about 6 to 18 months. The fitting of grommets requires referral to an ear, nose, and throat (ENT) specialist.

Hearing usually returns to normal after the grommets have been fitted. However, if hearing or language development issues persist despite grommets having been fitted, a hearing test may be required.

Other treatments

In some cases, a tonsillectomy (surgical removal of the tonsils) may be necessary for the eustachian tubes to work correctly.

Use of antibiotics, decongestants, antihistamines, and corticosteroids will not help glue ear.

Prevention

The risk of glue ear can be reduced by:

• Not smoking in the presence of infants and children
• Breastfeeding for as long as possible (3 to 6 months)
• Feeding infants in an upright position when bottle feeding
• Avoiding allergy triggers
• Treating ear pain or infection promptly
• Encouraging older children to blow their nose rather than sniff
• Teaching toddlers how to blow their nose
• Keeping the home warm and dry
• Making sure children have their hearing checked before staring school
• Keeping your children’s vaccinations up-to-date.

Further information and support

Healthline

Freephone: 0800 611 116

Website: www.healthline.govt.nz

PlunketLine

Freephone: 0800 933 922

Website: www.plunket.org.nz

References

KidsHealth (2018). Glue ear (Web Page). Auckland: Paediatric Society of New Zealand and Starship Foundation. https://www.kidshealth.org.nz/glue-ear [Accessed: 19/02/19]

KidsHealth (2018). Grommets (Web Page). Auckland: Paediatric Society of New Zealand and Starship Foundation. https://www.kidshealth.org.nz/grommets [Accessed: 19/02/19]

MedlinePlus (2018). Otitis media with effusion (Web Page). Bethesda, MD: US National Library of Medicine (NIH). https://medlineplus.gov/ency/article/007010.htm [Accessed: 19/02/19]

NHS (2017). Glue ear (Web Page). Redditch: National Health Service (NHS)

England. https://www.nhs.uk/conditions/glue-ear/ [Accessed: 20/02/19]

Created: March 2019

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