Key points
- Most glue ear resolves without intervention within 3 months. Active treatment is indicated for persistent or impactful cases.
- Autoinflation with the Otovent device is the recommended first-line active intervention in NICE guidance.
- Hearing aids are an option to support development during the period of management.
- Grommets (ventilation tubes) are highly effective for persistent bilateral glue ear with hearing loss.
- Surgical referral is appropriate when glue ear has been present for more than 3 months with associated hearing loss.
Glue ear (otitis media with effusion) is the accumulation of fluid in the middle ear. It is common, largely self-limiting, but capable of causing meaningful hearing loss and developmental impact during the years when language acquisition is most active. The treatment approach is therefore proportional to the severity and persistence of the condition, not uniform.
Watchful waiting
For a child with a first presentation of glue ear, particularly where the hearing loss is mild and there is no significant developmental impact, a period of watchful waiting of up to three months is appropriate. Approximately half of all cases of glue ear resolve within this period without any intervention.
During the waiting period, review appointments should confirm whether the condition is improving, static, or worsening, and assess any impact on speech, language, and educational progress.
Autoinflation
Autoinflation involves the child using an Otovent balloon device, which is inflated through the nostril, to generate positive pressure in the nasopharynx. This pressure opens the Eustachian tube and encourages drainage of the middle ear fluid.
The TARGET trial, a UK-based randomised controlled trial, found that children who used the Otovent device showed significantly better outcomes at one month and three months compared to controls. NICE now includes autoinflation in its guidance for management of OME, recommending it for children who are able to perform the technique (typically from age 3 to 4 upwards).
The technique requires practice and parental support initially. A brief demonstration and guidance on frequency of use (typically three times daily) is needed at assessment.
Hearing aids
Where glue ear is causing a significant hearing loss and the child is in an important developmental period for language, hearing aids can be fitted to provide auditory support while the condition is managed or monitored. Conventional behind-the-ear hearing aids are suitable for most children, though bone conduction hearing aids are available for those where conventional fitting is not appropriate.
Hearing aids do not treat the glue ear itself. They address the functional consequence of the hearing loss and protect language development during the management period.
Grommets
Grommet insertion (myringotomy with ventilation tube) is a surgical procedure performed under general anaesthetic, typically taking 15 to 20 minutes. A small incision is made in the eardrum, the fluid is suctioned from the middle ear, and a small ventilation tube is placed in the incision to maintain ventilation of the middle ear space.
Grommets typically extrude naturally within 6 to 12 months as the eardrum heals. In most cases, grommets produce immediate improvement in hearing, and recurrence of glue ear after extrusion is less common in older children whose Eustachian tube function has matured.
NICE guidance on grommets
NICE Guideline NG91 recommends grommet insertion for children with persistent bilateral OME with hearing loss that has been present for at least 3 months. The guidance also notes that hearing aids are an alternative where surgery is not acceptable to the family or where there are contraindications to general anaesthetic.
When to refer to ENT
If glue ear has been present for more than 3 months, is bilateral, and is associated with a hearing loss of 25 to 30 dBHL or more, referral to an Ear, Nose and Throat surgeon is appropriate. The decision about whether to proceed with grommets will then be made in discussion between the surgeon, the family, and the audiologist based on the child’s specific situation.
