This is a problem, otherwise clinically known as persistent otitis media with effusion, that affects up to 10% of children in the UK at some point in their childhood, but is commonest between the ages of 2 and 5.
The fluid is of variable consistency, is not infected and it is thought to occur due to enlarged adenoids and/or the lining of the middle ear producing more mucus than it ordinarily should.
It is slightly more common in males than females, is found more readily in the colder months and is frequently found in children with Downs Syndrome.
The net result is that hearing deteriorates and this can have profound effects on the young child. Not only can they start shouting, turning up the TV or ignoring people, but their speech development can suffer as does their behaviour, manifesting in either isolation or disruptive events.
The diagnosis is made by examining the ear and then performing a hearing test. Remember, there needs to be a history of persistent problems before deciding on any intervention. This is usually defined as a period of 3-6 months.
Glue ear in adults is uncommon but, if it occurs, it is usually after a nasty ear infection that has resolved, leaving non-infected fluid. In a minority of cases, it may signify problems in the back of the nose (post nasal space) in the form of a benign of malignant mass. Thus, if grommets are inserted in adult patients, it is mandatory to check that there are no suspicious lesions present in the post nasal space.
Grommets. These are small, synthetic tubes that are inserted into the ear drum under a general anaesthetic. They act as a temporary eustachian tube, letting air into the middle ear cavity. They last between 6 – 12 months and then fall out spontaneously. This helps the mucosa to dry up by returning to normal, the function of the eustachian tubes. In 1/3 of children, a further grommet(s) need to be inserted. If numerous grommets have been used, a more permanent grommet called a T-Tube or Permavent tube can be used to give relief for up to 3 years.
Hearing aids. This clearly does not resolve the middle ear fluid but helps to amplify the sounds being presented to the ear. Most children prefer not to have this modality as it makes the feel almost handicapped and thus the focus of potential bullying.
• Patients are followed up every 3-6 months in my outpatient clinic to make sure that the grommets are not causing problems and also to confirm that the hearing is returning to normal.
• Infections after insertion occur in about 15% of children but this easily resolved with a low dose antibiotic ear drop for 2-3 days. The ear must be kept dry.
• Scarring of the ear drum (tympanosclerosis) is common (50% of cases) but it is harmless and merely signifies that there has been a grommet insertion in the past.
• Persistent perforation of the ear drum is rare (1%). Usually this is well tolerated with conservative treatment but it can be repaired if there are problems with discharge. The incidence of persistent perforation is higher with the longer term grommets (5-10%).
• It is advisable to keep the ears dry for 3 weeks afterwards, paying particular attention to avoiding soapy water. Swimming after this is usually well tolerated but diving is not a good idea as it can force water into the ear. If the patient is concerned about wetting the ear the good swimmers ear plugs can be purchased from a sports shop.