Glue Ear & Grommets

What is glue ear? 

Glue ear (otitis media with effusion) is a condition in which fluid accumulates in the middle ear behind the ear drum. It is the commonest cause of hearing impairement in children and it is estimated that one in four children are affected with glue ear at some stage of their lives.

The Eustachian tube is the tube that connects the middle ear to the back of the nose. Its principal function is to ventilate the middle ear and maintain equal air pressure between the outside and inside of the middle ear. When the tube becomes obstructed or does not function effectively, 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.

Initially the fluid is thin and watery but eventually it maybecome thick, hence the name ‘glue ear’. As the middle ear air is replaced by fluid the transmission of sound through the middle ear is affected and the hearing thresholds levels are reduced. Obstruction of the tube may be due to repeated infections, enlarged adenoids or nasal allergy.

As the child gets older there is a change in size and orientation of the Eustachian tube, and a lesser tendency to get infections. As a result, children usually grow out of glue ear. However, it can take a long time, although it usually resolves by the age of 12. Because of the impact it has on the hearing, glue ear may lead to delayed speech development, behavioural and/or educational problems.

Blockage or malfunctioning of the eustachian tube leads to fluid buildup in the middle ear.

Treatment of glue ear

Watchful waiting

In a significant proportion of children the glue ear resolves over time. Commonly, therefore, specialists tend to wait a few months (usually 3 months) to see if the glue ear resolves. In some special circumstances in it is not in the interests of the child to wait even for 3 months. If your child falls in this category your doctor will discuss it with you.

Grommet insertion

The principal method of treating children with glue ear is with ventilation tubes (grommets).The main objective of grommet insertion is to get rid of the fluid in the middle ear by ventilating the middle ear. If glue ear was the sole cause of the hearing loss, normal hearing will be restored once the fluid is displaced and middle ear ventilated

What does the operation entail?

Under general anaesthetic a small hole is made in the ear drum. The fluid is removed and a grommet is inserted. This is a daycase procedure, and the minimal pain that the child may experience is usually well controlled with simple painkillers.

Are there any complications?

Infection

There is a small risk of infection, which is commonly treatable.

Perforation

Grommets usually work their own way out of the ear drum and the ear canal on average after 6-18 months. After the grommet has come out of the ear drum the hole that was created to insert the grommet, usually heals itself. In a small proportion of cases it does not, and the child is left with a permanant hole (perforation) in the ear drum which may need repair at a later date. Rarely, the grommet stays in place for many years and needs to be removed.

When can the child go back to nursery school?

Usually children are well enough to go to school a day or two after the procedure.

Can my child go swimming?

Yes, as long as they swim on the surface and avoid deep water diving. (Some specialist have different opinions, so check with your doctor).

Are there any alternatives to grommets?

There is little evidence that any medical therapy is of benefit. One option is for the child to be fitted with hearing aids instead of having grommets. This will overcome the hearing loss, and over time the fluid should resolve spontaneously.

Links:

http://www.ndcs.org.uk/family_support/our_publications/glue_ear_2.html