Glue Ear In Children

Key points to remember about glue ear

• ‘glue ear’ is caused by thick fluid behind the eardrum (middle ear)
• it can affect one or both ears
• it can cause difficulty hearing
• glue ear may impact how a child learns to talk
• spoken words may not sound as clear to tamariki with glue ear

A bit about the ear

The eardrum has a space behind it that should be full of air. This allows sound to vibrate or gently move the eardrum, which is essential for hearing well.

What is glue ear?

Glue ear happens when your child's middle ear (the space behind the eardrum) is filled with fluid. The fluid can be very thick and sticky, which is why it is called 'glue' ear. It can affect one or both ears. Hearing is normally worse if both ears are affected. 

Glue ear can start from fluid not clearing after an ear infection. Some tamariki get glue ear without having been unwell and may not have complained of sore ears. The risk factors for glue ear are the same as for ear infections. 

The fluid in glue ear is not caused by swimming or water getting into the ear. The outer ear (or ear canal) has no connection with the space behind the eardrum (unless there is a hole or grommet in the eardrum).

Causes of glue ear

During an ear infection, infected fluid fills the space behind the eardrum. It is common for this fluid to take a few weeks to clear away, even if your child has had antibiotics. The fluid gradually clears down the small tube (the eustachian tube), which connects the space behind the eardrum to the back of the nose. 

After an ear infection, the fluid clears away completely within 3 months for 80% of tamariki. If the fluid doesn’t clear from the middle ear space after 3 months, this is often called glue ear. 

The medical name for glue ear is otitis media with effusion or OME. Glue ear can happen when eustachian tubes become blocked and do not work well. This can be caused by frequent colds, enlarged adenoids (at the back of the nose), or allergies that cause the nose to be blocked. 

Check the information on ear infections for an explanation of how fluid can build up in the middle ear.

Ear Infections In Children

Why glue ear is a problem

For tamariki to hear normally, their middle ear needs to be full of air. When there is fluid instead of air, it is harder for the eardrum to vibrate and carry the noise vibrations to the inner ear. This makes it harder for tamariki to hear. If one ear is affected, they can sometimes manage OK, but if both ears are affected, your child's hearing can be significantly reduced. 

Young tamariki who have hearing loss for long periods can have problems with learning to talk and learning how to pronounce words clearly. With older tamariki, it can also affect their learning at school.

Hearing Problems In Children

Signs and symptoms of glue ear

Tamariki with glue ear are not usually unwell. They don’t usually complain of any ear pain. Their only symptom may be hearing loss. This may not be something that is easily noticed, and not something they complain about. It is sometimes picked up on a screening preschool hearing test or by a health professional when they are doing a general check of your child’s ears. 

It is always a good idea to ask your health professional to check your child's ears at every opportunity. Always tell them if you have any concerns about your child’s hearing or language development.

Hearing loss

The amount of hearing loss in tamariki with glue ear varies. For your child, it can be like trying to hear with earplugs in place - sounds are muffled.

Young tamariki can't tell you about their hearing loss. If your child is not hearing well, they may:

• ask you to repeat things or say “huh?” or “what?” often
• seem to ignore you or not answer when you speak to them
• not hear things properly
• want the TV or music volume turned up louder
• have a delay in learning how to talk or picking up new words
• have difficulty learning how to pronounce words clearly

Some tamariki manage very well, despite not hearing normally. In these tamariki, there may be no noticeable problems and they do not complain, because their hearing seems normal to them.

Behaviour problems

Reduced hearing may cause behavioural problems, such as a lack of concentration or attention. Tamariki may feel irritable if they keep missing out on what others are saying.  If the glue ear is affecting speech development, this can cause frustrations about not being understood.

Sleep problems

Although the fluid in the middle ear does not usually cause pain, parents may sometimes say their child doesn't sleep well.

How glue ear is diagnosed

The health professional will talk with you about what's happening with your child.

Looking in your child's ears

They will look into your child's ears with an otoscope. An otoscope is a small, powerful light with a magnifying lens.

Many tamariki do not like having their ears examined. To make it easier, the health professional may encourage you to comfort your child by:

• holding your child sitting sideways on your lap
• wrapping one of your arms gently over their arm
• gently holding their head against your chest with your other hand

It can sometimes be helpful to talk to your child before you go to the appointment. You can tell them that a special torch will be used to shine a light into their ears.

Tympanometry

Sometimes it can be helpful to assess how well the eardrums are moving. This is done with a special instrument called a tympanometer. This looks very similar to an otoscope and is held to the outer part of the ear in a similar way. If there is fluid in the middle ear, it can measure that the eardrum is not moving well.

Tympanometry is not a hearing test, but it helps give information about the space behind the eardrum, which can sometimes be difficult to see.

Hearing test

Sometimes, a health professional may recommend a hearing test for your child. Hearing tests are done differently for tamariki of different ages. 

Managing glue ear

In many tamariki,  the fluid or ‘glue’ in the middle ear can clear away without needing any treatment. Sometimes this can take a few months. For this reason, your health professional may simply recommend regular checkups for up to 3 months so they can examine your child's ears. If your child has fluid in the middle ear for more than 3 months, there are some treatment options.

Regular checkups

If your child's hearing and development are normal, a health professional may recommend this option. As your child gets older, the fluid is more likely to clear away with time. This is because their eustachian tubes mature and generally work better as they get older. 

It is important to take your child to a health professional for regular checkups during this time.

Grommets

Some tamariki with glue ear may benefit from grommets. These are very small plastic tubes that are placed in the eardrum. Grommets help keep air in the space behind the eardrum, which improves hearing. 

Grommets require a short general anaesthetic to put in. They are designed to be temporary, usually staying in place for around a year. If your child does need grommets, your health professional may recommend an appointment with an ENT (ear, nose and throat) specialist to assess your child and discuss this option further.

Grommets In Children

Are there other treatments for glue ear?

Longer courses of antibiotics have been used in the past as treatment for glue ear. But, there are concerns about the side effects from having of long courses of antibiotics, including the development of antibiotic resistance, allergic reactions, diarrhoea and thrush. There is no good evidence that long courses of antibiotics work for glue ear. This is because active infection is not present in glue ear, so multiple or longer courses of antibiotics are not recommended when there are no signs of infection.

The following treatments also don't work and should not be used as treatment for glue ear:

• decongestants (such as Pseudoephedrine, Otrivin)
• steroids (such as Prednisone)

How to help your child with glue ear

If your child has glue ear, they may not be able to hear you. It can be helpful to get their attention before you speak to them. 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 reduce background noise.

Let your child's teachers know that they have glue ear and ask if they can sit towards the front of the class. Teachers will be aware of the importance of making sure tamariki hear as well as possible. They will understand they will need to get their attention if they are speaking with your child when they have glue ear.

When to get medical help for your child with glue ear

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 one of the ear nurse specialists. They are specially trained to diagnose, treat, monitor and refer tamariki with middle ear problems.

If your child has glue ear for more than 3 months or repeated episodes of persistent middle ear fluid, they should be referred to an ENT (ear, nose and throat) specialist. Your GP can do this. Your GP or ENT specialist may arrange a hearing test for your child.

If your child has had grommets inserted and you are still concerned about their hearing or they have other developmental issues, they may need a hearing test and further assessments. Make sure you discuss your concerns with your health professional.