Glue Ear & the Insertion of Grommets
What is Glue Ear?
Glue ear is a common condition that affects children.
Its medical name is ‘otitis media with effusion’ or ‘secretory otitis media’ which describe the build-up of a sticky glue-like fluid in the middle ear, behind the eardrum.
What are the symptoms?
The symptoms of glue ear vary with age.
You may notice that your child gets repeated ear infections and may seem slower to develop speech, understanding and walking compared to other children.
When they start school, they may have difficulty hearing the teacher and so may get behind in their work.
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.
Diagram showing the anatomy of the healthy, ‘normal’ ear
What causes Glue Ear and how common is it?
The ear is responsible for hearing and balance and is made up of three parts – the Outer Ear (the parts of the ear which you can see and the ear canal), the Middle Ear (the ear drum and three tiny bones called ossicles), and the Inner Ear
Sound waves travel through the ear canal to the eardrum (a thin, taut membrane) and cause it to vibrate.
The ossicles amplify these vibrations and carry them to the Inner Ear. The Inner Ear translates the vibrations into electric signals and sends them to the brain where they are interpreted as sound.
To work properly, the Middle Ear must be at the same pressure as the outside world. This is achieved by the Eustachian Tube, a small passage that connects the Middle Ear to the back of the throat behind the nose.
By letting air reach the Middle Ear, the Eustachian Tube keeps the air pressure in the Middle Ear equal to the outside air pressure. The Eustachian Tube also allows for drainage of mucus from the Middle Ear into the throat.
We are not exactly sure what causes Glue Ear but doctors believe it is related to the Eustachian Tube not functioning properly.
If the tube is blocked, this causes the air pressure inside the Middle Ear to drop and fluid drains from the surrounding tissue to fill up the Middle Ear. With time, this fluid becomes sticky and stops the ear drum and ossicles vibrating as they should.
The blockage might be due to enlarged adenoids, congestion from a cold (which is why it is more common in winter), pet allergies, pollen, dust or passive smoking.
It is estimated that one in four children are affected with Glue Ear at some stage of their lives. However, it mainly affects young children between the ages of two and five years.
How is Glue Ear diagnosed?
The doctor will start by looking inside your child’s ear to see if there is any visible blockage of the ear canals and to check the appearance of the ear drum.
This will be followed by some hearing tests to see whether there is any hearing loss and if so, whether it is caused by Glue Ear. One of these tests (tympanometry) assesses the mobility of the ear drum and can give an indication of whether glue is present.
How is Glue Ear treated?
In most children, the condition clears up on its own.
However, if it persists and starts to affect their speech, language or schooling, the doctor may suggest treatments using grommets which are inserted during an operation.
Grommets are tiny tubes that are inserted into the ear drum and allow air to pass through the ear drum. This keeps the air pressure equal on either side.
Are there any alternatives?
Left untreated, Glue Ear may lead to delayed speech, long-term hearing loss and behavioral or educational problems.
Medical treatment with decongestants or steroids has not been shown to be particularly effective unless there are signs of infection or allergy and for persistent Glue Ear, grommets are the treatment of choice.
In addition the use of an auto inflation device called Otovent helps in improving the function of the Eustachian Tube and treating mild cases.
What happens before the operation?
Before you come into hospital an ENT (Ear, Nose & Throat) doctor in the Pre-Admission Clinic will assess your child. The doctor will check your child is well and still requires the planned operation. This may involve another hearing test when you arrive if your child hasn’t had one recently.
You will then see the Pre-Admission Nurse who will check your child’s details and explain about coming into hospital.
When you come into hospital, the doctor will ask you to sign a consent form for your child’s operation and another doctor will also visit to explain about the anaesthetic.
If your child has any medical problems, particularly allergies, please tell the doctors about these. Also bring any medicines your child is currently taking.
What does the operation involve and are there any risks?
The surgeon makes a tiny hole in the ear drum and inserts the grommet into the hole. The grommet usually stays in place for six to twelve months and then falls out. This is normal and will not affect your child.
Every operation carries some risk of infection and bleeding but as the hole in the ear drum is tiny, this risk is very much reduced.
Around one in every 100 children may develop a perforated ear drum. If this persists it can be repaired at a later date.
What happens after the operation?
After the operation, your child will return to the ward for at least 3 hours to fully wake up from the anaesthetic. Once he or she feels comfortable, has had something to drink and eat and has passed urine, you will be able to take your child home.
Give regular pain control medicine (e.g. paracetamol) for the first 24 hours to prevent your child becoming uncomfortable.
There may be some oozing or bleeding from the ear – this is normal and should stop within a few days.
Do not clean the inside of the ear – only the outside.
Gently clean the ears using a twist of cotton wool or a very soft cloth. Never use a cotton bud as you may go too far into the ear and cause damage.
Care should be taken not to allow water to get into your child’s ear. Earplugs can be bought from the chemist or cotton wool with a layer of Vaseline can be used during washing, bathing and showering to prevent water, soap and shampoo entering the ear canal. With the earplugs or cotton wool/Vaseline protection, your child can also continue to go swimming provided they do not put their head under water.
Flying is actually easier for children with grommets in the ears. The grommet allows air in and out of the ear and reduces the stress on the ear drum that is caused by changes in air pressure in the aircraft.
You will be seen in the ENT Outpatients Department at some point after the operation. Your appointment details will be sent to you in the post.
If there are any problems before then, please see your GP or contact the Children’s Surgical Ward.
What is the outlook for children with Glue Ear?
Once Glue Ear has been diagnosed and treated, the outlook is very good.
Most children with speech and language delays caused by Glue Ear catch up and go on to have a normal school life. A small proportion of children may
need extra help from a Speech and Language Therapist.
Grommets usually stay in place for six to twelve months and then fall out. They move outwards with earwax until they fall out of the ear canal, often unnoticed. Occasionally they stay in place and may require another operation to remove them.
Over half of children who have grommets do not need further surgical treatment as they get older.
However, some children will need grommets inserted a number of times until their Glue Ear improves.
Although the ear drum is tough, repeated grommet insertions may eventually scar it which can sometimes cause a hearing loss.