Glue Ear and Grommets

Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

What is glue ear?

Glue ear is fluid in the middle ear, behind the ear drum. Some other names you may hear glue ear called are Otitis Media with Effusion or maybe Mucoid Otitis Media.

How did it get there?

The lining of the middle ear 'sweats' fluid all the time and this fluid usually empties out automatically when our ears "pop", for example when we swallow or yawn. When a middle ear infection or a head cold occurs this fluid may not be able to empty out as it normally would. The fluid is thin at first, but if the middle ear stays inflamed the fluid can't get out and air also can't get in, this fluid may become thick, like glue.

Air would normally enter the middle ear through the Eustachian tube, which is a tube that runs between the middle ear and the back of the nose, and is closed but opens for a moment every time we swallow. If the Eustachian tube is not working properly, such as from swelling from an infection, for example a head cold, it may not allow air to get into the middle ear, or the fluid to get out.

This thick fluid is the "glue" in glue ear.

How could this glue affect my child?

Your child hears poorly through this thick fluid and may seem deaf (and need the TV up louder) or seem inattentive, off-balance or irritable. If this occurs then your child needs to see your family doctor.

The reason this build up of fluid affects your child's hearing is that the tiny bones of hearing and the ear drum can not move freely because of the thick fluid. This is called a conductive hearing loss.

Children should not be left for long periods with untreated glue ear. The hearing loss which occurs in this case may affect your child's speech development, understanding of language, reading and spelling.

How can it be treated?

If your child normally has good hearing and speech, your family doctor may prescribe antibiotics but will usually wait a few weeks, checking your child frequently to see that the fluid disappears naturally. The amount of time this takes can depend on how long the fluid has been present. If the middle ear fluid does not disappear or if your child has hearing loss or speech problems, your family doctor may refer you to a specialist.

Your child may need grommets (tiny tubes) put in the eardrum to let air into the middle ear and allow the fluid to drain.

What are grommets?

Grommets are very small ventilation tubes made of plastic that are about 2mm in width. The grommet sits in the eardrum with one flange sitting on the inside and one on the outside of the eardrum.

Grommets are known by a few different names but they all work in the same way to allow air into the middle ear. Some of the other names are, ventilation tubes, drainage tubes, Shepard's tubes, Collar button tubes and T- tubes, you may hear other names as well so ask your doctor to explain this to you.

How do they work?

Grommets are ventilation tubes which have a small hole in the centre which allows fresh air to enter the middle ear to keep it free of fluid.

Once air can enter the middle ear it helps to improve your child's hearing by allowing the tiny bones of hearing to move freely again.

The grommets will gradually fall out of the drum after three - eighteen months. Most children's hearing will recover fully. The fluid may come back in some children and further treatment will be needed. Some children need grommets again.

Will my child need to go to hospital to have grommets inserted?

Yes, your child will need to be in hospital to have the grommets inserted. It is a day only procedure so they will not need to stay overnight unless your child is having another operation at the same time.

Your child will come into hospital the day they are having their operation. It is important that they don't have anything at all to eat or drink before the operation. The hospital will advise you what time your child needs to be 'nil by mouth'.

Before the operation commences your child will be given an anaesthetic to put them into a deep sleep so that they will not feel any discomfort during the procedure.

After surgery your child will be able to go home within a couple of hours, when they have woken up and had something to drink.

What do I need to know about grommets when at home?

Your child shouldn't have too much pain after the operation, if they do have a lot of pain or discharge from the ear which continues for longer than a few days you should contact your doctor.

After your child has the grommets inserted you need to maintain "water precautions" until the grommets have come out of the ear drum and it is fully healed.

It is very important that you maintain water precautions with your child to keep dirty water containing germs out of their middle ear while they have grommets. Dirty water is water that is hard to keep free from bacteria, for example heated pools, spas, rivers, creeks, lakes and dams.

Bath water is also dirty water so your child should wear ear plugs in the bath if they are going to put their head under water.

There are a few different things you can use as ear plugs

• Custom made ear plugs can be made by hearing aid suppliers
• Soft plastic plugs can be bought at some shops
• Silicone ear putty
• Blu-tack
• Cotton wool smeared with Vaseline

It is important that if you use putty or blu-tack that you use a piece as big as your child's outer ear and not a piece small enough to get stuck in the ear canal.

Can we still go swimming?

Yes, but not for the first 2 weeks after the operation. After that you should keep dirty water out of the child's ears. When they are swimming they will need the ear plugs and a swimming cap or earband or earwrap to hold the plugs in place while they swim.

What if water gets in my child's ears while the grommets are there?

Chances are nothing will happen. But an ear infection can develop with discharge from the ear and hearing loss needing treatment straight away with ear drops and possibly antibiotics. Sometimes further surgery is needed because of the infection. Your child will not be able to swim until the infection is gone.

Swimming with an ear infection is not only silly for your child; it can also spread the infection to other people.

Do I need to know anything else?

Because hearing loss occurs in glue ear, it is very important that your child has a hearing test after the glue ear is better. This is available in some hospitals, community health centres, in some ear, nose and throat specialists' offices or at Australian Hearing Services. If hearing is not back to normal, further investigation is needed.

If your child has grommets they will need to have their ears checked regularly to see if the grommets are still in the ear drum and still working.

• Glue ear should not be left untreated for long periods of time.
• Your child should have a hearing test after they have their grommets.
• Your child should use water precautions when swimming in dirty water or in the bath until the grommets are out.

This article is from http://www.chw.edu.au/parents/factsheets/glue_ear_and_grommets.htm 

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Glue ear - by Rae Fry - from ABC health and wellbeing

Glue ear is a build-up of gunk inside the middle ear cavity. It's the most likely reason that children under five will end up on the operating table, often unnecessarily.

Published 27/03/2003

[Image source: iStockphoto] 

Glue ear is a build-up of gunk inside the middle ear cavity. It sounds innocuous, but it's the most likely reason that children under five will end up on the operating table, often unnecessarily.

The surgery involves inserting grommets, or ventilation tubes, in the eardrum. These help dry up the fluid - but for most children it's not the fluid itself that's the problem. Rather, it's the muffled hearing that can result, as the fluid impairs the vibration of the small bones in the ear cavity that transmit sound.

Surgery isn't usually necessary, however. Most cases of glue ear will clear up by themselves, and some researchers believe that surgeons tend to be too hasty.

What is glue ear?

Medically known as otitis media with effusion, glue ear is different from acute otitis media, which is a short-term ear infection.

Both involve inflammation of the middle ear ('otitis media'), both involve a build-up of fluid, and both are common in babies and young children. Four out of five children will get at an ear infection at some stage.

But unlike glue ear, acute otitis media is accompanied by short-lived pain and fever. Acute otitis media can sometimes turn into glue ear, or the reverse can happen: glue ear can lead to an acute infection.

Infections (such as a cold or flu) are thought to contribute to glue ear, but sometimes glue ear just happens for no apparent reason. Glue ear may also result from an allergy, though doctors disagree on this.

The reason young children are most vulnerable to glue ear is because their Eustachian tubes (the passage between the middle ear and throat) are short and narrow, so can get blocked easily. Fluid secreted in the middle ear is trapped, rather than simply draining into the throat.

Glue ear is a build-up of fluid in the middle ear.

Although all children are susceptible to ear infection, children exposed to lots of other children in group day care or at home are at significantly more risk (since exposure to other children increases the chances of catching a cold). Aboriginal children and children from lower socio-economic groups are also at high risk.

There are other risk factors (like exposure to tobacco smoke, bottle feeding, and being a boy), but they seem relatively less important.

Symptoms

Glue ear is not obvious from the outside and it usually goes undetected. Often the first thing a parent notices is hearing loss: the child may not respond to quiet sounds, does not turn around when you walk up behind them, sits close to the television, and seems inattentive.

Whether or not fluid is present can be confirmed by an ear examination.

Diagnosis

A lighted instrument called an otoscope is used to look for changes in the external ear canal and eardrum. A version of this instrument called a pneumatic otoscope also enables the doctor to blow a puff of air against the eardrum to see how well it moves. This makes it much more accurate in detecting glue ear, but many Australian doctors aren't trained to use it.

Other instruments and tests, such as tympanometry, may also be used by audiologists to diagnose ear problems. Tympanometry measures pressure differences between the middle ear and outer ear by measuring how easily the eardrum vibrates back and forth.

To measure whether the fluid is causing hearing loss, a separate hearing test is necessary.

Treatment

Most cases of glue ear will clear up by themselves. But for many years, parents and professionals have worried that hearing loss may interrupt a child's speech, language development, and behaviour. Now it seems that glue ear by itself may be much less damaging than previously thought.

The amount of hearing loss suffered varies between zero and 60 decibels, with an average of 25 decibels. A 25 decibel hearing loss softens normal speech, so it sounds more like a whisper.

Treatment options include:

• Watchful waiting. About 30 per cent of cases will clear in several weeks without treatment, rising to about 90 per cent of cases in several months.

• Antibiotics. Before opting for surgery, a course of antibiotics may be tried. This will only be helpful if there is a bacterial infection present - studies suggest antibiotics may help only in about one in four cases.If antibiotics are used, it's very important that all medicine be given to the child as prescribed rather than stopping partway through, even if symptoms have disappeared. Usually, only one course would be prescribed. Antibiotics may have side effects such as nausea, diarrhoea, and rashes. Also, if they are over-used, disease bacteria can become resistant to them, making them less effective generally.

• Auto-inflation. Another way to get air into the middle ear cavity is via the nose and Eustachian tube. This may be done by holding your nose and 'popping' your ears, or using a balloon-like device which the child blows up with their nose (yes, their nose). The few studies that have been done on auto-inflation have had mixed results: on the whole, it may help, and probably doesn't do any harm.

• Surgery. If the child's hearing loss is 30 decibels or more in both ears, and continues for more than three months, surgery may be recommended. It involves making a small cut in the eardrum (called 'myringotomy' or 'tympanostomy') and inserting tiny circular tubes (called 'grommets', 'ventilation tubes' or 'tympanostomy tubes') into the cut to hold it open and allow air to pass through. Surgery involves the risk associated with an anaesthetic, and there are also potential complications. The grommets are supposed to come out by themselves after six to 12 months, but they may fall out earlier or later. Sometimes they may cause an infection or a permanent hole in the eardrum.
  
  There is no doubt that grommets effectively relieve hearing loss over the first six months or so, but they may give little benefit in the long term because most children will 'catch up' with speech and language development. Only a few well-designed studies have been done, and most suggest that grommets make little or no difference to children's speech and development over time. More research is necessary to decide for sure. However, many parents report an immediate improvement which they think is worthwhile.

• Allergy treatment. Studies are conflicting about whether allergy treatment for glue ear is effective. There have been some good results, especially in children who have had several sets of grommets and still have fluid in the ear. In such cases, the inflammation may be caused by an allergy rather than by an infection, and so allergy testing and treatment (such as desensitisation treatment, food elimination diets, or house dust mite control) may help.

• Speech therapy. If you think your child has speech, language or development problems, check these out while you're checking out the ears - don't wait until after the grommets! Language problems are common in preschool children with and without glue ear, and should be assessed in their own right - regardless of the presence of middle ear fluid.