BASED ON ENT-UK WEBSITE
Glue ear is a condition in which fluid accumulates in the middle ear behind the ear drum. The build up of fluid in the middle ear is due to a problem of blockage of the tube that connects the middle ear to the back of the nose (Eustachian tube). The Eustachian tube normally plays an important role in maintaining equal air pressure between the outside and inside of the middle ear. When the tube becomes obstructed, the air in the middle ear becomes absorbed and the resulting vacuum draws fluid into the middle ear cavity from the lining of the ear (the mucosa).
Initially the fluid is thin and watery but eventually it becomes thick and tenaceous, hence the name ‘glue ear’. Because the middle ear is now filled with fluid rather than air, the hearing is muffled. Obstruction of the tube may be due to repeated bacterial and viral upper respiratory tract infections, enlarged adenoids or nasal allergy.
It is important to note that in children the Eustachian tube is more horizontal and smaller than in adults and this is one of the reasons why glue ear is relatively common in children.
Because of the change in size of the Eustachian tube as you get older, and becaue you tend to be less prone to infections as you get older, children usually grow out of glue ear. However, it can take a long time, although it usually resolves by the age of 12. Glue ear may lead to delayed speech development, behavioural or educational problems.
Grommets are very small plastic tubes, which sit in a hole in the eardrum. They let air get in and out of the ear. Grommets usually fall out by themselves as the eardrum grows. They may stay in for six months, or a year, or sometimes even longer. You may not notice when they drop out.
Glue ear tends to get better by itself, but this can take a while. We like to leave children alone for the first three months, because about half of them will get better in this time. After three months, we see the child again and decide whether we need to operate. If the glue ear is not causing any problems, we can just wait for it to settle by itself.
If glue ear is causing problems with poor hearing, poor speech or lots of infections, it may be better to put grommets in. If we do put in grommets, the glue ear may come back when the grommet falls out. This happens to one child out of every three who has grommets put in. We may need to put more grommets in to last until your child grows out of the problem.
Nose drops or steroid nasal sprays can sometimes help. Antibiotics and antihistamines do not seem to help this type of ear problem. Alternative treatments, such as cranial osteopathy do not seem to be helpful.
Taking out the adenoids may help the glue ear get better, and reduce the chance of needing a further set of grommets. This can be carried out at the same time as putting grommets in.
A hearing aid can sometimes be used to treat the poor hearing and speech problems that are caused by glue ear if you are not keen on the idea of grommets.
Speak clearly, and wait for your child to answer. Make sure he or she can see your face when you speak. Call your child’s name to get them to look at you before you speak. Let nursery and school teachers know that your child has a hearing problem. It may help for your child to sit at the front of the class.
Grommets are not usually sore at all. Grommets should improve your or your child’s hearing straight away. Some children think everything sounds too loud until they get used to having normal hearing again. This usually takes only a few days. You should be able to go back to work or school the day after the procedure.
Most people with grommets do not get any ear infections. If you see yellow fluid coming out of the ear, it may be an infection. It will not be as sore as a normal infection, and your child won’t be as ill. If you get some ear drops from your doctor, the problem will quickly settle. Some doctors may give antibiotics by mouth instead of antibiotic ear drops. Grommets are sometimes used to reduce the number of ear infections.
Swimming is fine but you should avoid diving or SCUB diving. To minimise the chance of infections you can use ear plugs. You do need to avoid getting dirty or soapy water into the ear, so in the bath or shower plug your ears with a cotton-wool ball covered in Vaseline.
It is OK to fly in an aeroplane with grommets. The pain from the change in pressure in the aeroplane cannot happen when the grommets are working. We need to check your hearing after grommets have been put in, to make sure their hearing is better. Sometimes when a grommet comes out, a small hole is left behind. This usually heals up with time, and we rarely need to operate to close the hole. The grommet can leave some scarring in the eardrum. This does not affect the hearing.