Key points to remember about glue ear
- with glue ear there is fluid in the space behind the ear drum (middle ear)
- glue ear can affect one or both ears
- the main symptom of glue ear is hearing difficulty
- hearing loss for prolonged periods of time during the early years may affect speech and language development
- speak to your family doctor if you are concerned that your child may have glue ear
What is glue ear?
Artwork copyright © Dr Peter Allen and printed with permission from the book 'Understanding ear infections'.
Glue ear occurs when the space behind the ear drum (middle ear) is filled with fluid. The fluid can be thick and sticky which is why it's called glue ear. Glue ear can affect one or both ears. It often follows an ear infection or can occur on its own.
See the page on ear infections for an explanation of how fluid can build up in the space behind the ear drum and a diagram of the inside of the ear.
Whether or not an ear infection has been treated with antibiotics, the fluid in the space behind the ear drum may stay around for weeks. However, the fluid usually clears up in 80 percent of children within 12 weeks. When there is fluid in the space behind the ear drum for more than a couple of weeks, it's called OME (otitis media with effusion) or secretory otitis media. These are the medical names for glue ear.
Why is glue ear a problem?
Normal hearing relies on the space behind the ear drum (middle ear) being full of air. When this air is replaced by fluid, it is harder for the ear drum to vibrate and carry the noise vibrations to the inner ear. This makes it harder for your child to hear. If both ears have fluid, your child's hearing can be significantly reduced. Hearing loss for prolonged periods of time during the early years may affect speech and language development. See:
What puts my child at risk of getting glue ear?
The risk factors for glue ear are the same as for ear infections. See the page on ear infections (particularly the sections 'Who gets ear infections?' and 'What puts my child at risk of getting ear infections?').
What are the signs and symptoms of glue ear?
Children with glue ear are not unwell and may have few symptoms other than hearing loss - the most important symptom. Often, glue ear is only found when your child is being examined for something completely different. It is always a good idea for you to make sure your family doctor checks your children's ears at every opportunity.
The extent of hearing loss in children with glue ear can vary but the average hearing loss is similar to trying to hear with ear plugs in place. Sounds are muffled.
Young children can't express this hearing loss and often parents mistakenly feel that their child is ignoring them. Signs to watch for include your child:
- asking for things to be repeated
- mishearing things
- wanting the television up louder
Reduced hearing may cause behaviour problems such as a lack of concentration or attention. Children may feel irritable if they keep missing out on what others are saying. Problems with speech and language development could be a sign of glue ear.
Although the fluid doesn't usually cause pain, sleep disturbance is often reported by parents.
How is glue ear diagnosed?
Your family doctor will ask you questions about your child's health and examine your child's ears. To do this they will use:
- an instrument called an otoscope to look at your child's ear canal and ear drum. An otoscope contains both a small powerful light and a low power magnifying lens
- and sometimes, tympanometry
Tympanometry is a test which uses a device to find out how well the ear drum moves back and forth. If there is fluid in the space behind the ear drum (middle ear), the ear drum does not move. Tympanometry is also used by vision and hearing testers as a screening tool for glue ear.
See Hearing probems in children on this website.
Tympanometry is not a hearing test and a 'pass' on this test does not necessarily mean that your child can hear well – it just means that it is unlikely they have glue ear at the time of the test.
If your child has glue ear for more than 3 months, they should see an ENT (ear, nose and throat) specialist. As part of an assessment by the specialist, a hearing test may be arranged.
What is the treatment for glue ear?
The best treatment for glue ear is time. In most children, episodes of glue ear get better without active treatment. For this reason, your family doctor may simply recommend regular appointments for up to 3 months so they can check your child's ears.
If your child has fluid in the space behind the ear drum for more than 3 months, treatment options include:
This may be an option if hearing and development are normal. As children grow older they are less likely to have glue ear. This is because their Eustachian tubes get bigger and work better. The Eustachian tubes connect the space behind the ear drum (middle ear) of each ear to the back of the nose.
See the page on ear infections (particularly the section 'Who gets ear infections?') for an explanation about why children's Eustachian tubes often don't work well.
Regular reviews by a health professional are necessary during this period.
Grommets (tympanostomy or ventilation tubes)
Some children with ongoing glue ear may require grommets - see the page on grommets (tympanostomy or ventilation tubes).
Which treatments are not recommended?
Treatments which have been used in the past and have been shown to be ineffective include decongestants (such as Pseudoephedrine), antihistamines (such as Phenergan) and steroids (such as Prednisone).
Longer courses of antibiotics have also been used in the past as treatment for glue ear. However, antibiotics only have a small impact on the clearance of fluid in the space behind the ear drum, and the benefit is probably only temporary. Because of this and concerns about the complications of prolonged use (including the development of antibiotic resistance, allergic reactions, diarrhoea and thrush) antibiotics are no longer routinely used as treatment for glue ear.
What can I do to help if my child has glue ear?
If your child has glue ear they may not be able to hear you. Remember to speak slowly and clearly to your child. Try to make sure your child can see your face when you are speaking to them and try to minimise background noise. It can be helpful to get their attention before you speak to them.
Let your child's teachers know that they may also need to get your child's attention before speaking, and that your child may need to sit at the front of the class to hear well. Glue ear is common and teachers are usually aware of the importance of making sure children hear well.
When should I seek help?
If you are concerned about your child's hearing or language development see your family doctor.
Some areas have mobile children's ear clinics which visit schools and early childhood education centres. If your area has a mobile clinic, you could also talk to the ear nurse specialists who staff these. They are specially trained to diagnose, treat, monitor and refer for children with middle ear problems.
If your child has glue ear for more than 3 months or repeated episodes of glue ear, they should see an ENT (ear, nose and throat) specialist. As part of an assessment by the specialist, a hearing test may be arranged.
If your child has had grommets inserted for glue ear, and continues to have hearing or developmental issues, a hearing test and further review by a specialist will be necessary.
You should also take your child to your family doctor if:
- your child's ear starts to discharge
- your child has a fever which doesn't go away after 24 – 48 hours
- you are worried about the unwellness of your child
You need to take your child to be seen by a doctor immediately if your child:
- has any swelling, redness or tenderness in or around the ear
- is feeding poorly
- has any change in consciousness
- has a stiff neck
- has sensitivity to light
Starship Foundation and the Paediatric Society of New Zealand acknowledge the cooperation of Procare Health Ltd in the development of this content. Procare Health Ltd provides GP (general practice) services in the greater Auckland area.
Diagrams / artwork:
Thank you to Dr Peter Allen for allowing reproduction of artwork from his book 'Understanding ear infections'.
Please note: Permission to copy kidshealth fact sheets, with acknowledgement, does not extend to Dr Peter Allen's artwork on this page. Any requests to reproduce this artwork need to be made in writing to:
Dr Peter Allen
Central Family Health Care
7 Mansfield Terrace