You are probably just walking out of an audiology appointment where you were told you were told your child has glue ear or you’ve been told by a friend that your child is probably not listening because they cannot hear you due to glue ear.
You’re wondering what this is and would like to know what this may mean for your child’s development. Could this be the reason they are not speaking yet? Is this why almost everyone struggles to understand their speech? Maybe this is why they have been acting a little off lately?
I answer these important questions from a Paediatric audiologist’s perspective and explain all you’ll need to know about glue ear in children so you can make more informed decisions about your child’s ear and hearing care.
So what is glue ear?
Glue ear, also known as otitis media with effusion (OME), is a condition where thick, sticky fluid accumulates in the middle ear behind the eardrum. This fluid buildup can affect the normal functioning of the middle ear, including the vibration of the eardrum and the transmission of sound to the inner ear, which can result in hearing loss or other symptoms.
Glue ear often occurs after an upper respiratory tract infection, such as a cold, and can be more common in children. It can cause symptoms such as muffled hearing, difficulty hearing or understanding speech, ear pain or discomfort, a feeling of fullness or pressure in the ear, and in some cases, balance problems or dizziness.
It is estimated that approximately 80% of children will have at least one episode of glue ear by the age of 10 years old. It is more common in young children, with peak incidence occurring between the ages of 2 and 5 years old. Glue ear is more common in children than adults due to several factors. Children have shorter and more horizontal Eustachian tubes, less developed immune systems, and are more likely to be exposed to viruses and bacteria that cause ear infections. They are also more likely to have allergies and larger adenoids, which can block the Eustachian tubes and lead to fluid buildup in the middle ear. While adults can also develop glue ear, these factors make children more susceptible to the condition.
Glue ear is different from acute otitis media, which is a bacterial infection of the middle ear that causes symptoms such as ear pain, fever, and often results in the buildup of pus or fluid behind the eardrum. In contrast, glue ear typically involves non-infected, thick fluid accumulation in the middle ear without the typical signs of acute infection.
Causes of Glue Ear
The exact cause of glue ear is not fully understood. However, several factors are believed to contribute to its development. These can include:
- Dysfunction of the Eustachian tube: The Eustachian tube is responsible for equalizing the pressure between the middle ear and the back of the throat. When the Eustachian tube doesn’t work properly, such as being blocked or not opening and closing properly, it can disrupt the normal drainage of fluid from the middle ear, leading to the accumulation of fluid and the development of glue ear.
- Adenoid enlargement: The adenoids are lymphoid tissue located near the opening of the Eustachian tube in the back of the nasal cavity. When the adenoids become enlarged, they can block or partially obstruct the Eustachian tube, leading to fluid buildup in the middle ear and the development of glue ear.
- Upper respiratory tract infections: Frequent colds or other respiratory infections can cause inflammation and swelling in the Eustachian tube, impairing its normal function and leading to glue ear.
- Allergies: Allergic conditions, such as allergic rhinitis or hay fever, can cause inflammation in the nasal passages and Eustachian tube, which can contribute to the development of glue ear.
- Secondhand smoke exposure: Exposure to secondhand smoke, especially in children, has been shown to increase the risk of developing glue ear.
- Genetic predisposition: There may be a genetic component to glue ear, as it tends to run in families, suggesting a possible genetic predisposition.
Symptoms of Glue Ear: What should I look out for?
We have observed that kids of different age groups will show slightly different glue ear symptoms. This is mainly due to factors such as their ability to communicate, stage of development, and age-specific activities they may be involved in.
Glue Ear Symptoms in Toddlers
In toddlers, glue ear (otitis media with effusion or OME) may present with the following symptoms:
- Hearing difficulties: Toddlers with glue ear may have difficulty hearing or responding to sounds appropriately. They may not respond to their name being called, have trouble following instructions or conversations, or show signs of confusion when trying to understand verbal cues. When parents or teachers are unaware they would commonly say “the child is not listening”.
- Speech or language delays: Glue ear can affect a toddler’s ability to hear and process speech, which can impact their speech and language development. Toddlers with glue ear may show delayed or impaired speech development, have difficulty pronouncing words or speaking clearly, or have trouble understanding and using language.
- Irritability or fussiness: Toddlers with glue ear may experience discomfort or pain in the ears, leading to irritability, fussiness, or disrupted sleep patterns. They may cry more than usual, become irritable or moody, or have difficulty settling down.
- Tugging or pulling at the ears: Toddlers may instinctively tug or pull at their ears in an attempt to alleviate discomfort caused by the fluid buildup in the middle ear. They may repeatedly touch or rub their ears, or show signs of discomfort when pressure is applied to the ears.
- Balance problems: Glue ear can disrupt the normal functioning of the inner ear, which can affect a toddler’s balance and coordination. Toddlers with glue ear may show signs of unsteadiness, clumsiness, or difficulty maintaining balance during activities such as walking, running, or playing.
- Speech sound errors: Toddlers with glue ear may have difficulty producing speech sounds correctly or may exhibit speech sound errors. They may struggle with articulation, mispronounce words, or have unclear speech.
If you are worried, let’s check if your child has glue ear
Glue Ear in Infants and Babies
Infants and babies have less verbal communication skills so you may notice one or a combination of the following:
- Hearing difficulties: Babies with glue ear may have trouble hearing or responding to sounds properly. They may not respond to their name being called, have difficulty locating the source of sounds, or not react to noises that would usually startle them.
- Delayed speech or language development: Glue ear can affect a baby’s ability to hear and process sounds, which can in turn impact their speech and language development. Babies with glue ear may show delayed or impaired speech development.
- Irritability or fussiness: Babies with glue ear may experience discomfort or pain in the ears, leading to irritability, fussiness, or difficulty sleeping. They may cry more than usual or have trouble settling down.
- Tugging or pulling at the ears: Babies may instinctively tug or pull at their ears in an attempt to alleviate discomfort caused by the fluid buildup in the middle ear.
- Balance problems: Glue ear can disrupt the normal functioning of the inner ear, which can affect a baby’s balance. Babies with glue ear may show signs of unsteadiness or clumsiness, especially when trying to sit up, crawl, or walk.
- Speech sounds or language delays: In some cases, babies with glue ear may have difficulty producing speech sounds properly or understanding language, which can be evident in their attempts at communication.
If you are worried, let’s check if your child has glue ear
How is glue ear diagnosed?
Glue ear is typically diagnosed through a combination of medical history, physical examination, tympanometry, and a hearing test for your child.
- Medical history: Your audiologist will ask about your child’s medical history as it relates to hearing, including any previous ear infections, hearing problems, or speech and language delays. It’s important to provide a detailed history of your child’s symptoms, including when they started, how long they have been present, and any factors you noticed exacerbate or improve the symptoms.
- Physical examination: Your audiologist will perform a thorough physical examination, which may include looking into your child’s ears using an otoscope, a device that allows visualisation of the ear canal and eardrum. At this point, they are looking for signs of fluid buildup behind the eardrum, such as a dull or opaque appearance of the eardrum, and may also check for other signs of infection or inflammation.
- Hearing assessment: A hearing assessment would be performed to evaluate your child’s hearing abilities. This should include a hearing test, such as a play audiometry, where your child listens to tones of different frequencies and volumes, or other age-appropriate hearing screening methods.
- Tympanometry: Tympanometry is a test that measures the movement of the eardrum in response to changes in air pressure. It is used to determine if there is fluid in the middle ear and how well the eardrum is functioning. A small tip would be placed in your child’s ear and the machine measures your child’s eardrum movement in a few seconds. It’s usually pain-free.
Complications of glue ear
A small percentage of children who have persistent glue ear that has been left untreated may develop complications in the following domains:
- Delayed speech and language development: If Glue Ear is not treated promptly, it can lead to hearing loss, which can in turn affect a child’s speech and language development. Children with Glue Ear may experience difficulty hearing and understanding sounds and words, which can result in delayed speech and language development.
- Behavioural problems: Children with Glue Ear may experience behavioural problems such as attention deficit hyperactivity disorder (ADHD), aggression, irritability, and social withdrawal due to their hearing difficulties.
- Ear infections: The presence of fluid in the middle ear can create a breeding ground for bacteria, increasing the risk of ear infections. These infections can cause pain, fever, and discharge from the ear.
- Eardrum perforation: In rare cases, the pressure caused by the fluid build-up in the middle ear can cause the eardrum to rupture or tear, resulting in hearing loss and potential infection.
- Long-term hearing loss: If glue ear does not resolve spontaneously and it is left untreated, it can lead to long-term hearing loss, which can have a significant impact on a child’s development and quality of life.
- Problems with balance: Glue Ear can also affect the balance system in the inner ear, leading to dizziness and problems with balance.
How can glue ear be treated?
The most effective glue ear treatment for your child would vary depending on the severity of the condition, the age of the child, and other individual factors. Some of the commonly used treatments for glue ear include:
- Watchful waiting: In cases of mild glue ear, where there are no significant symptoms or complications, your audiologist may choose a “watchful waiting” approach. This involves reviewing your child 3 months after the initial diagnosis to see if the fluid has resolved. Where the fluid is still present in the follow-up appointment and the hearing has not improved the child is referred to an Ear, Nose, and Throat specialist for consideration of grommets.
- Medications: Medications, such as nasal decongestants or corticosteroids, may be prescribed in some cases to help reduce inflammation and congestion in the Eustachian tube and middle ear, facilitating the drainage of fluid. However, the effectiveness of medications (especially antibiotics for glue ear) in treating glue ear is still debated, and they may not always be recommended as a first-line treatment.
- Hearing Aids for Glue Ear:
In cases where glue ear is causing significant hearing loss, hearing aids may be recommended to improve hearing and minimise the impact of hearing loss on speech, language, and other developmental aspects. Hearing aids for glue ear are designed to conduct sound through the skull, bypassing the sticky glue and sending the sound directly to the cochlear.
- Glue Ear Balloon (Otovent):
Otovent is a device that is sometimes used as a treatment option for glue ear. It involves blowing up a small balloon through the nostrils to help equalise pressure in the middle ear and potentially facilitate fluid drainage from the ear. Regular glue ear exercises with the otovent has been shown to resolve glue in a lot of cases.
- Grommets for glue ear drainage:
Grommets, also known as tympanostomy tubes, are small tubes that can be inserted into the eardrum by a surgical procedure. They help equalise pressure in the middle ear and allow fluid to drain, preventing the buildup of fluid in the middle ear. Grommets are a common treatment option for persistent or recurrent glue ear, especially in cases where other treatments have not been effective.
How to prevent glue ear
There is no guaranteed way to prevent glue ear, but there are some steps that can reduce the risk of developing the condition:
- Avoid exposure to secondhand smoke: Secondhand smoke is a known risk factor for glue ear. If you smoke, quitting can also help reduce the risk.
- Breastfeed infants: Breastfeeding for at least six months can help prevent glue ear in infants.
- Practice good hygiene: Frequent hand washing and cleaning surfaces can help prevent the spread of viruses and bacteria that can cause ear infections.
- Keep your child’s immunizations up to date: Immunizations can protect your child against infections that can lead to glue ear. Make sure your child receives all the recommended vaccines, including those for the flu, pneumonia, and measles.
- Avoid allergens: If you or your child have allergies, taking steps to avoid allergens can help prevent ear infections.
- Manage reflux: Gastroesophageal reflux disease (GERD) can increase the risk of developing ear infections. Treating GERD may help reduce the risk of glue ear.
Remember, these steps can help reduce the risk of developing glue ear, but they may not completely prevent it. If your child is experiencing symptoms of glue ear, such as hearing loss, it is important to speak to your GP for a referral to your local audiology department or contact us if you would like your child to be seen privately.
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Glue ear and speech delay
Glue ear (otitis media with effusion) can contribute to speech delay, and regression in some cases. The accumulation of fluid in the middle ear can affect a child’s ability to hear and understand speech properly, which may lead to speech delays or difficulties. If a child has previously developed speech skills and then experiences glue ear, the hearing loss caused by the condition can impact their ability to hear and produce speech sounds accurately. This may result in regression or deterioration of speech skills that were previously acquired. Early detection and management of glue ear, including addressing any hearing loss, can help mitigate the potential impact on speech development and prevent speech regression.
Glue Ear and other conditions
Glue ear has been found to be associated with other conditions in children, such as cleft palate, down syndrome, and allergies. Now let’s explore the relationship between glue ear and these other conditions:
Glue Ear and Cleft Palate
Up to 90% of children with cleft palate would suffer from glue ear even for patients who have had their cleft repaired. Children with cleft palates are at a higher risk of developing glue ear due to the connection between the middle ear and the back of the nose. The opening that connects the middle ear to the nose, called the Eustachian tube, may not function properly in children with cleft palate, making them more susceptible to fluid buildup in the middle ear. Early identification and treatment of glue ear is important to prevent hearing loss and other complications in these cases.
Glue Ear and Down Syndrome
Children with Down syndrome are more likely to experience ear infections and glue ear due to abnormalities in the Eustachian tube and a weakened immune system. These factors can lead to fluid buildup in the middle ear, which can cause hearing loss and other complications. Early identification and treatment of glue ear is important to prevent further hearing difficulties in children with Down syndrome.
Glue Ear and Allergies
Allergies may contribute to the development of glue ear in some children. Allergic reactions can cause inflammation in the middle ear, which can lead to fluid buildup and hearing loss. Identifying and treating allergies may help prevent the development of glue ear in susceptible children.
Glue Ear Private Treatment
Most cases of glue ear would resolve spontaneously. However, episodes can last for a few months to years sometimes depending on the cause. The challenge is that glue ear is most prevalent in infants and toddlers, the age group who need good hearing to develop normal speech and language.
If there is a significant hearing loss caused by the glue ear, managing the hearing loss associated with glue ear with hearing aids designed for glue ear should be the priority. This will enable your child still have access to speech sounds at a clear and audible level while we wait for the glue ear to resolve.
Remember, a huge percentage of learning for children is incidental. This approach means they can consistently access sounds in their environment.
Hearing aid for glue ear: In my experience, the safest hearing aids for glue ear are bone anchored/conduction hearing aids. These hearing aids are designed specifically for glue ear and bypass the fluid in the middle ear, delivering the sound directly to your child’s cochlear. However, there is a paucity of private specialists who offer this specialised hearing aid service.
Let’s help your child hear again and catch up with their speech
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If you are at the stage where you are already considering grommets and want to go privately, there are a lot of options for you in the UK. The cost of private grommet treatment can vary depending on the provider. In general, the cost of private ear grommet insertion can range from around £2,000 to £3,000 or more per ear. It is important to carefully research and compare providers and their fees, as well as to check if insurance coverage or payment plans are available.
Glue ear, or otitis media with effusion (OME), is a condition where fluid accumulates in the middle ear behind the eardrum, leading to hearing loss or other symptoms. The exact cause is not fully understood, but dysfunction of the Eustachian tube, adenoid enlargement, upper respiratory tract infections, allergies, secondhand smoke exposure, and genetic predisposition are believed to contribute to its development. Glue ear can present differently in different age groups, but common symptoms include hearing difficulties, speech or language delays, irritability or fussiness, tugging or pulling at the ears, and balance problems. Early diagnosis and appropriate management of the hearing loss or treatment using ear grommets, are important to prevent potential long-term complications.