What Is Glue Ear? What Causes Glue Ear?

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Main Category: Ear, Nose and Throat
Also Included In: Pediatrics / Children's Health;  Hearing / Deafness
Article Date: 14 Oct 2009 - 13:00 PST

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Glue ear, also known as secretory otitis media, otitis media with effusion, or serous otitis media, causes a glue-like fluid to accumulate in the middle ear, which should be filled with air. Glue ear is a common cause of dulled hearing in young children. In the majority of cases symptoms resolve themselves in time without treatment being required. When symptoms persist the child will probably need some kind of therapy.

Treatment in which a child blows up a balloon using their nose has been shown to help in a number of cases. Sometimes an operation is performed to clear the fluid and insert grommets if the condition persists.

According to Medilexicon's medical dictionary, glue ear is "middle ear inflammation with thick mucoid effusion caused by long-standing eustachian tube obstruction."

The ear and hearing

The human ear is divided into three parts:

• The outer ear
• The middle ear
• The inner ear

Sound waves enter the outer ear and hit the eardrum, making it vibrate. In the middle ear, behind the eardrum there are three ossicles - tiny bones, called the malleus, incus and stapes.

The vibrations pass to these three bones from the eardrum. The bones transmit the vibrations to the cochlea, which is in the inner ear. The vibrations are converted into sound signals by the cochlea. These sound signals go down the ear nerve to the brain which processes the information - and we hear.

The area behind the eardrum (middle ear) should be filled with air. Any fluid that does build up there is usually drained out through the Eustachian tube. The Eustachian tube connects the middle ear to the back of the nose - most of the time this tube is closed. When we swallow, chew or yawn the Eustachian tube sometimes opens - this is when fluid has a chance to drain out. The Eustachian tube also helps maintain the right air pressure within the middle ear.

If the Eustachian tube is blocked, because of an obstruction or inflammation, a vacuum of air can build up which sucks fluid into the middle ear cavity from mucus that exists in other parts of the ear. Initially, this fluid is watery, but it can eventually become viscous and glue-like.

If the glue like substance builds up enough, it can stop the incus, malleus and stapes from vibrating properly. If they cannot transmit the vibrations to the cochlear, the child will not hear properly - sounds will be muffled.

How common is glue ear?

Approximately 70% of all children will have had glue ear by the age of four years. It is much more common among children under eight than other people. Adults are much less likely to develop the condition because their Eustachian tube is bigger and less horizontal than a child's.

• Glue ear is more common in boys than girls.


• Glue ear is more common in homes where somebody regularly smokes indoors.


• Children who have frequent coughs, colds or ear infections are also more likely to develop glue ear.


• If a child has a sibling who has/had glue ear they are more likely to develop it themselves.


• Bottle fed babies are more likely to develop glue ear, compared to breast fed babies.

What are the signs and symptoms of glue ear?

A symptom is something the patient feels or reports, while a sign is something other people, including the doctor may detect. For example, a headache could be a symptom while a rash may be a sign.

The following signs and symptoms are possible:

• Hearing loss - in the majority of cases the hearing loss is mild. The child may have muffled hearing in one ear. However, for some children the hearing loss is severe and they can eventually become almost completely deaf. If both ears are affected the deafness is usually more intense. If the fluid in the ear is very thick the child's hearing loss will be greater.
  
  A very young child may lose some hearing and not be aware of it. Parents and other adults and siblings might notice some of the following signs or symptoms which could indicate either hearing loss or a problem with the ear(s):
  
  
  • Language problems
  • Social interaction problems
  • Not heeding some verbal instructions
  • Turning the TV/radio or other sound equipment up
  • Being less responsive to sounds (especially in babies)
  • The child says "Pardon?" when talked to, more than usual
  • Slight earache (less common, but possible)

Any earache could also mean that an infection has developed.

How is glue ear diagnosed?

In many cases the child is unaware of having a hearing problem and the condition is detected during a standard hearing test.

The GP (general practitioner, primary care physician) will initially try to find out whether the child's ear is blocked - this could be an object or earwax. If no blockage is detected the doctor will use an otoscope to examine the eardrum. If the eardrum appears to be sucked inwards the child most likely has glue ear. The eardrum will be sucked inwards because a vacuum has formed behind it. The doctor may also notice that:

• The eardrum is not vibrating properly
• There is fluid present
• There are bubbles present
• The eardrum has changed color (orange or amber)

The child may be referred to an audiologist - this is a health care professional who specializes in hearing loss and related disorders. The audiologist may perform or order the following tests:

• Audiogram - this is a hearing test to find out whether the patient is able to hear sound at varying frequencies and levels of loudness. The child wears headphones and will indicate when a sound is heard, or not heard. Most children enjoy doing the test.


• Tympanometry - this test measures the function of the middle ear; more specifically, the eardrum. Varying levels of pressure are applied within the ear canal and the movement of the eardrum (tympanic membrane) is measured. The test does not take long and can be performed on all children, including babies.


• The McCormick toy test - this test is aimed at very young children (under 4). The health care professional whispers the name of something in the child's ear. The child has to point to the object to show that he/she heard correctly. The test can help the health care professional gauge the child's ability to detect quiet sounds.

What are the treatment options for glue ear?

As a significant proportion of glue ear cases resolve themselves without treatment, doctors usually recommend watchful waiting. This means doing nothing but monitoring the child's and the condition's progress carefully. Studies have shown that medication is not generally an effective therapy for glue ear.

The child will typically have a hearing test every three months. The patient may be referred to an ENT (ear, nose and throat) specialist if:

• The hearing problems persists
• There is discharge coming out of the ear, especially if it is smelly
• There is severe hearing loss
• The child has a disability
• There are developmental difficulties, such as with speech, language or behavior
• Glue ear is recurrent (keeps coming back)

The ENT specialist may recommend one of the therapies or procedures:

• Autoinflation - the child blows up a balloon device with his/her nose. This action can open up the Eustachian tube, which in turn makes it more likely that fluid in the middle ear drains away. The child will usually have to come back for a number of sessions until all the fluid is gone. Some children find this procedure difficult to do. Autoinflation does not always work.


• Grommet insertion - a small incision is made in the eardrum into which a tiny ventilation tube (a grommet) is inserted. The grommet helps drain away the fluid which has collected in the middle ear behind the eardrum; it also helps maintain proper air pressure, preventing a vacuum from forming.
  
  This procedure is done under a general anesthetic. The child can usually go home on the same day as the procedure.
  
  After 9-15 months the eardrum will begin to heal and push the grommet out. About 1 in 3 children usually need further grommets to complete the treatment.


• Adenoidectomy - the adenoids are surgically removed. The adenoids are masses of lymphoid tissue behind the nose, in the upper part of the throat. They are part of our immune system. If they are swollen they can block the Eustachian tube, while surgically removing them significantly increases the likelihood of unblocking it. The procedure is done with a general anesthetic and the child can typically go home the same day. A grommet insertion as well as an adenoidectomy are often performed simultaneously.


• Hearing aid - if the child's hearing loss is severe the doctor may recommend the child uses a hearing aid until the glue ear is resolved and hearing is restored.

How to help the child

A child who has hearing problems may find certain aspects of life harder to cope with. If your child is going through a period of hearing loss, the following steps may help him/her:

• When communicating with your child verbally, do not shout, but talk clearly and more loudly than you would to a child who has no hearing problems.


• Talking to your child in a quiet setting, with no background noise will make for better communication.


• When talking to your child make sure he/she can see your face.


• Attract the child's attention before speaking to him/her.


• Accept that there may be frustrations and some behavior changes.


• Keep in touch with his/her teacher. A good teacher will know how to help him/her. This may include sitting the child closer to the teacher, or wherever verbal utterances are taking place in the classroom.


• Protect your child from tobacco smoke. If people in the household smoke, ask them to do it either outside, or somewhere that does not expose the child to smoke.

What are the possible complications of glue ear?

• Developmental problems - if a child cannot hear properly their development may be affected. Left untreated, or not detected, hearing loss may undermine a child's social skills, as well as their confidence and self-esteem. The child may also suffer academically.


• Acute ear infection - the sticky glue that builds up behind the eardrum can eventually become infected, causing pain and fever. If your child is known to have glue ear and experiences earache or has an elevated body temperature, tell your doctor immediately.
  
  An ear infection can result in a perforated ear drum, which can temporarily affect hearing. In the majority of cases a perforated eardrum is not serious, and will heal within a month. In very rare cases a tympanoplasty may be needed (operation to repair the eardrum).


• Tympanosclerosis - after a grommet is inserted the eardrum tissue may thicken. This increases the risk of a serious eardrum perforation, resulting in tinnitus (noise in the ears), pain and bleeding.

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today