We have been told that our daughter has a ‛glue ear'. Will this cure itself or will she need grommets? What are grommets?

In the first instance, it may help to know how the ear is made.

It is divided into three parts: the first part is the ear canal known as the external acoustic meatus (the part your doctor will look into to see the ear drum). The second part is the middle ear, known as the tympanic cavity, separated from the ear canal by the ear drum (tympanic membrane). The middle ear contains the ossicles, three tiny interconnected bones that are attached to the ear drum and vibrate when sound waves hit the ear drum. These vibrations are transmitted to the inner ear (the third part) by the ossicles, and here the are translated into sound by all the complicated structures (see the blue snail-like structure in the diagram) that are directly connected to the brain via the vestibulocochlear nerve (the hearing and balance nerve).

The Eustachian tube (see the auditory tube in the diagram) is also very important in the function of the ear as it helps clear naturally occurring fluid away from the middle ear and well as maintain equal pressure between the middle and the outer ear (which is why you hold your nose and blow when you are in an airplane and you need to "pop" your ears) by means of ventilation. It is connected to the base of the throat.

What is Glue Ear[i]?

Glue ear, also known as Otitis Media with Effusion in medical jargon, is the accumulation of mucousy non-pussy fluid in the middle ear (tympanic cavity).

It is very common, but exact figures of how many children have glue ear are unknown. It is thought to be most common in children under the age of 2 (about 20%) and thought to decline by the age of 6. It is also thought that most children will have at least one episode of glue ear during their early childhood.

Although not always the case, glue ear tends to follow an episode of middle ear infection (Acute Otitis Media) and is therefore more common in the winter months.

It usually is the result of the auditory tube (see diagram) getting clogged up and failing to clear fluid from the middle ear after an episode of Acute Otitis Media. This results in an ongoing collection of fluid in the middle ear (known as effusion) which tends to glue up the ossicles, hence the terminology Glue Ear.

There are also other suggested causes for glue ear such as low-grade infections, nasal allergies, large adenoids or even gastro-oesophageal reflux, all thought to hinder the drainage of fluid from the middle ear - but these are less common.

Why is glue ear important to recognise?

The main reason for which it is important to recognise glue ear is that it may impair your child's hearing. This happens because, as mentioned previously, the tiny bones that normally conduct sound from the ear drum to the inner ear are all glued up and no longer able to vibrate and conduct sound. The degree of hearing loss does vary, but glue ear is thought to be the commonest cause of childhood hearing loss in he UK. As logic would dictate, this may affect your child's speech and language development as well as his or her overall learning, leading to academic and behavioural difficulties. Clumsiness or balance issues may also be a problem.

Untreated glue ear may also be associated with chronic ear infections (lots of lovely mucous for bugs to live in) and may result in permanent damage to the ear drum with associated hearing loss.

How do you know your child has glue ear?

You might find that you child has frequent ear infections diagnosed by your doctor, and that as time goes by you are developing concerns about you child's speech, language or behavioural development.

Glue ear is diagnosed when your doctor suspects it from your child's history and refers you to the audiologist for a hearing test. The audiologist with not only see how much your child can hear, but will also look at the ear drum for fluid behind it (the "glue") as well as do a special test known as "pneumatic otoscopy" to assess the mobility of the ear drum. In this test air is puffed against the ear drum and the movement of the drum is measured: if it doesn't move much then it is likely that there is plenty of "glue" behind it within the middle ear.

What are the treatment options?

The condition is usually self-limiting, however if it lasts longer than three months or there are concerns about hearing or speech and language development a referral for a hearing test must be made. A referral to a Ear Nose and Throat (ENT) specialist must be made if the above applies and there is significant hearing loss (more than 25 decibels).

If it is felt that treatment is needed, options include the insertion of grommets as well as removal of adenoids if these are felt to be contributing to the problem. The use of antibiotics, steroids, decongestants, antihistamines or mucolytics (medication that dissolves mucous) is not recommended in the management of glue ear.

But what are grommets?

A grommet (can also be known as a ventilation tube) is a tiny tube that is inserted into the ear drum (under general anaesthetic), that essentially does the work that the clogged up Eustachian tube should be doing. It allows air into the middle ear, thereby helping the Eustachian tube to become unclogged and do it's job draining the mucous out of the ear and letting air in. Once in place the grommet is painless and the child can hear (parents often report a dramatic difference). The grommet will usually work its way out of the ear drum (you might find it on your child's pillow!) within six to twelve months, allowing the drum to heal up (the ear drum has great healing capacity). It is important to know though that about 20-25% of children may need another set of grommets for recurrent glue ear.

Sometimes fluid can leak out of the middle ear through the grommet - if this becomes a problem or smells unpleasant do get your doctor to check the ear.

Also, when your child has grommets you must be careful about swimming and bathing - the jury is slightly out on this one but it is recommended that one should either avoid immersing the head in water or one should wear ear plugs to avoid water entering the middle ear.

The alternative to grommets is for your child to wear hearing aids until the condition resolves, but your child will need constant follow up until symptoms settle.

Please remember that if you have any concerns about your child's hearing or language development it is important to consult your doctor.

[1] www.cks.library.nhs.uk/otitis_media_with_effusion/view_whole_topic#252408001

[1] www.besttreatments.bmj.com

[1] www.mydr.com.au/printerfriendly.asp?Article=3205