Glue Ear

Paediatric Otolaryngology - Glue Ear

Is your child suffering from Glue Ear?

We are happy to help you understand more about "Glue Ear in Children". However, doing online research on this topic will not help to solve the ear problem. Please make sure you will bring your child to see the best ENT specialist.

Professor Thomas Havas is one of the few ENT specialists in Australia who has post-fellowship training in Paediatrics. Please feel free to eithercall us or use the "Book an Appointment" form to arrange an appointment to see him.

What is Glue Ear?

Glue ear is also known as Chronic Otitis Media with Effusion. Acute Otitis media is a viral or bacterial infection of the middle ear that causes pain and fever. On examination the eardrum looks inflamed, hyperaemic and may be bulging.

Glue Ear in Children

Occasionally the eardrum bursts resulting in mucopurulent ear discharge. This infection often settles quickly and requires no treatment but sometimes antibiotic treatment is required.

Otitis media is recurrent when the infection occurs three or more times in six months. Repeated middle ear infections are likely to occur in children:

  • in a child day care setting
  • with intercurrent upper airway obstruction such as adenoid hypertrophy
  • with rhinosinusitis
  • exposed to cigarette smoke or other irritants
  • with any upper airway mucosal immune deficiency problems

If fluid persists in the middle ear cleft for more than three months the condition is known as chronic otitis media with effusion or glue ear. The fluid is usually sterile and it varies in viscosity from thin to thick and sticky. Glue ear is nearly always due to eustachian tube dysfunction, is more common in children under the age of three because when we are born the eustachian tube is horizontal and orientation very thin and as we grow the tube becomes wider and more vertical. It is more common in children with rhinosinusitis as inflammatory swelling can cause blockage in the tube. It is more likely to develop in the colder seasons and it is more common with associated structural abnormalities such as cleft palate.

The thick and sticky fluid interferes with the transmission of sound through the middle ear and can cause mild or moderate hearing loss. Most cases of glue ear settle down without the need for active medical treatment however treatment may be needed if glue ear is present for more than 3 months and especially if it is associated with:

  • Documented hearing loss
  • Scarring or damage to the ear drum
  • Evidence of damage to the three bones in the middle ear

Evidence is quite strong that children with an ongoing conductive hearing loss due to glue ear often experience a delay in speech and language development, have learning difficulties at school, behavioural problems, frequent ear aches and may suffer from imbalance.

Long term complications of glue ear

  • Thinning of the eardrum
  • Collapse of the eardrum with formation of retraction pockets. This can lead to damage to the small bones of the middle ear further impairing the ability to heal. Deep posterior retraction pockets can lead to cholesteatomas. A cholesteatoma is an abnormal ingrowth of skin from the outer ear canal into the middle ear canal and nearly always requires surgical removal.


Glue Ear Treatments

Antibiotics

Antibiotics do not hasten the resolution of fluid in the middle ear cleft. They work by chemoprophylaxis – while the fluid is there they reduce the number of infections in the blocked middle ear. The problem with using antibiotics is the development of resistant organisms in the middle ear.


Grommets (Medits)

Grommets are small metallic or polyteflon tubes placed through the eardrum to help treat either recurrent acute otitis media or glue ear. For more information about grommets, please visit this page.


Steroids

Several American studies have shown that systemic steroids in appropriate doses, by their non specific anti inflammatory effect, can hasten the resolution of the middle ear fluid. Unfortunately when the steroids are discontinued, the fluid tends to re-accumulate. Due to the potential risks of oral steroids their use is no longer recommended by either the American Academy of Otolaryngology, Head & Neck surgery or the American Academy of Paediatrics.


Mechanical therapy

In older children the use of nasal balloon technique (Otovent) has been shown to be successful in hastening the resolution of middle ear fluid. It should always be used before considering grommets. In younger children, use of the Tonybee manoeuvre is recommended if the child is old enough to be able to swallow with it’s nose pinched.



If your child is suffering from Glue Ear, please contact Havas ENT Clinic on 02 9387 7360, or book an appointment online. We are here to help.