About this factsheet

This factsheet is part of RNID's medical range. It is for parents of children who have glue ear. Adults rarely get glue ear but the information in this factsheet may help them.

You should read this factsheet to find out:

What is glue ear?

Glue ear is the build up of a sticky glue-like fluid in the ear. A healthy middle ear (the space immediately behind your eardrum) contains air and no fluid. This helps the eardrum to vibrate freely in response to sound. Glue ear can cause temporary deafness.

Glue ear is a very common condition in young children aged between two and five years. In most children, glue ear clears up on its own. However, up to 5% of children get persistent glue ear which, if left untreated, can cause permanent hearing loss. Doctors call inflammation of the middle ear 'otitis media' and if it results in glue ear, they call this 'otitis media with effusion'. 

What are the symptoms of glue ear?

The symptoms of glue ear are not always very obvious. Glue ear can affect a child's hearing, although the hearing loss may not be present all the time and may fluctuate. This can sometimes make it difficult to know if your child is having hearing problems.

If their hearing is affected, a child may sometimes not respond when talked to, may find it difficult to concentrate and quickly get tired and irritable. Young children may be slow to develop speech. Older children may be able to tell you if they cannot hear very well. You may notice that they say 'pardon?' or 'what?' a lot or that they turn the television up loud.

How does a child get glue ear?

To understand how a child gets glue ear and how it affects hearing, you need to understand how the ear and hearing system works (see our leaflet "Ears and ear problems" (opens new browser window)) .

Sound waves enter the ear and move along the ear canal until they reach the eardrum, causing it to vibrate. A chain of three small bones (ossicles) in the middle ear link the eardrum to the inner ear. These bones transmit the vibrations from the eardrum to the cochlea in the inner ear, where there are thousands of tiny sound receptors. From here, the 'sound message' is passed along the nerve of hearing to the brain.

The middle ear needs to be full of air to let the eardrum and small bones vibrate freely. Air reaches the middle ear through the eustachian tube, which connects the middle ear to the back of the nose and throat. The eustachian tube is closed for 95% of the time and only opens when you swallow or yawn.

If the eustachian tube can't open properly, you get a vacuum in the middle ear.

Children have a smaller, more horizontal eustachian tube than adults do. This makes it more likely to become blocked, which stops it from opening properly. This can lead to a vacuum in their middle ear. Once this vacuum has formed, the lining of the middle ear becomes inflamed. To begin with, a thin fluid seeps out from this lining into the middle ear space. This is what happens if your child has an ear infection or if the Eustachian tube is blocked for other reasons. The fluid can then become thicker, causing 'glue ear'. Fluid in the middle ear especially if it thickens, can prevent the eardrum and small bones from vibrating which affects hearing.

What causes glue ear?

Glue ear is more common in winter and more common in boys than girls. Many children can get glue ear because of:

Passive smoking may also cause glue ear in some children. Some children with palate problems, such as a cleft palate, can keep getting glue ear.

What happens if glue ear is untreated?

Glue ear usually goes away by the age of seven to eight years and the condition improves on its own before adolescence in 95% of children. When glue ear does not clear up and it is not treated, it can result in permanent hearing loss. This is because over a long period it may cause permanent changes to the eardrum.

How is glue ear treated?

If you are worried about your child's hearing and think they may have glue ear, you need to take your child to see your GP. At the first visit, your GP will:

The treatment your GP offers for glue ear will depend on:

Your GP may prescribe antibiotics if they notice an infection or if your child has pain. Some GPs prescribe oral decongestants (tablets) to thin the fluid in the ear and help it drain away, but there is no convincing evidence that these help. Some GPs prescribe antihistamines or nasal steroids in the form of drops or sprays for children with allergies.

As most children recover naturally from glue ear, GPs usually adopt a wait-and-see approach to begin with. Your child will normally be observed for about three months to see if they need further treatment. If your child continues to have problems, your GP may decide to refer them to an ear, nose and throat (ENT) consultant at a hospital or clinic near you.

What will happen if we have to see an ENT consultant?

The ENT consultant will examine your child's ears and treat the symptoms of glue ear. Your child will also be seen by an audiologist who will carry out hearing tests and 'tympanometry'.

The hearing tests

Hearing tests will help the audiologist find out your child's level of hearing and how well their middle ear is working. Your child will be played different sounds via headphones, through a small vibrating pad on their head or through loudspeakers and the audiologist will make a note of which sounds your child responds to. These tests do not cause any discomfort and children usually find them interesting.

Tympanometry

Tympanometry tests the eardrum to find out if it is moving normally and also tests how well the middle ear is working. It can be carried out on all children, including babies. It should not be painful and takes less than a minute for each ear. A graph called a tympanogram will show the results immediately.  

What are grommets?

If your child has had glue ear over a few months and hearing tests have shown that this is causing a hearing loss, they may need a 'grommet' or ventilation tube. This involves making a small hole in the eardrum, removing the fluid and inserting the grommet through the hole. The grommet keeps the hole open for a few months, lets air into the middle ear space and lets fluid in the middle ear drain away. Your child's hearing should then return to how it was before they had glue ear.

This procedure is known as a myringotomy and grommet insertion. It is carried out under a short general anaesthetic and takes about 15 minutes. Your child will usually be allowed to go home the same day.

What happens to the grommet?

The grommet slowly moves outwards as the eardrum heals. It is then naturally pushed out of the eardrum into the outer part of the ear. It moves outwards with ear wax until it falls out of the ear canal, often unnoticed.

Most grommets fall out nine to 15 months after insertion. If the grommet becomes loose in the air canal it can easily be removed at an ENT clinic. Over half of children who have grommets do not need further surgical treatment as they get older. However, 30% of children will need grommets inserted a number of times until their glue ear improves. Although the eardrum is tough, repeated grommet insertions may eventually scar it, which can sometimes cause a mild permanent hearing loss.

Looking after a child with grommets

The hole in the eardrum for grommet insertion is small. However, it is worth taking a few simple precautions to stop water getting into your child's ear:

Flying is actually easier for a child with a grommet in their ear. The grommet allows air in and out of the ear and reduces the stress on the eardrum that is caused by changes in air pressure in the aircraft. However, children who have a history of frequent ear infections or who have had grommets in the past (but no longer have them) are occasionally at risk of perforation of the eardrum when flying. If you are worried about this, ask your GP.

About 5% of children with grommets get an ear discharge at some time, often after a cold. This is usually not serious or painful, but it is important to keep your child's ears clean and to consult your GP as soon as possible. Your GP will usually prescribe antibiotics or eardrops.

If your child gets a lot of discharge, gently clean their ears using a twist of clean cotton wool or a very soft cloth. Never use a cotton bud as you may go too far into the ear and cause damage. If infections are treated quickly, the ears will get back to normal with the grommets in place in most children.

Other surgical treatment for glue ear

Other surgical treatment for glue ear involves an 'adenoidectomy'. This involves taking out your child's adenoids, which are tissues (similar to tonsils) at the back of the nose. This might be recommended if it is thought that the adenoids are enlarged and contributing to your child's glue ear. An adenoidectomy is commonly carried out in children over the age of three and is thought to help stop your child getting glue ear again.

Removing their adenoids does not harm your child. Adenoids are removed through the mouth under general anaesthetic and your child is usually allowed to go home the same day.

How can I help my child?

If your child has glue ear, you can do a number of things to help:

Glue ear usually stops being a problem well before adolescence. But you should bear in mind that while waiting to see if glue ear clears up on its own or waiting for grommet surgery, children sometimes have reduced hearing for quite some time and will need help with communication. They may need to use a hearing aid and have support at home and school. Here are some ways in which you can make communication easier with your child:

Where can I get further information?

British Association of Otorhinolaryngologists - Head and Neck Surgeons (BAO-HNS)

This organisation represents medical practitioners including surgeons, trainees and audiologists. Their website contains patient information on the ears, nose, throat, conditions of the head and neck, and on facial plastic and cosmetic surgery. The organisation is also known as ENT UK.
ENT UK at the Royal College of Surgeons, 35-43 Lincoln's Inn Fields, London WC2A 3PE
Telephone: 020 7404 8373
Fax: 020 7404 4200
Email: admin@entuk.org
Website: ENT website  (external link, opens new browser window)

National Deaf Children's Society (NDCS)

NDCS works for deaf children and their families.

NDCS, 15 Dufferin Street, London EC1Y 8PD
Telephone: 0808 800 8880
Textphone: 0808 800 8880
Fax: 020 7251 5020
Email: helpline@ndcs.org.uk
Website: National Deaf Children's Society (external link, opens new browser window)

Further information from RNID

RNID Information Line

The RNID Information Line offers a wide range of information on many aspects of deafness and hearing loss. You can contact us for printed copies of this factsheet and the full range of RNID information factsheets and leaflets.

RNID Information Line, 19-23 Featherstone Street,  London EC1Y 8SL
Telephone: 0808 808 0123
Textphone: 0808 808 9000
Fax: 020 7296 8199
Email: informationline@rnid.org.uk

Acknowledgement:

This factsheet was produced with the help and advice of Philip J Robinson FRCS, FRCS (Otol), Consultant Adult and Paediatric Otolaryngologist at the Department of Otolaryngology, Southmead Hospital, Bristol.

RNID Information, September 2006