DISCLAIMER: This is for general information only. Rarer aspects of glue ear are not discussed. Always check with your own doctor.

What is a Glue Ear?

Glue ear is when you have fluid in the middle ear space. The middle ear space is the space behind the ear drum. This space is normally filled with air and contains the hearing bones which join the ear drum to the inner ear.

The fluid behind the ear is often very thick and viscous with a ‘glue like’ consistency – hence the name ‘Glue Ear’.

The fluid can be thin and watery and it is then sometimes known as a ‘Secretory Otitis Media’.

Understanding Glue Ear video?

This is a good video by NHS Choices which explains how the ear works, why children get glue ear and treatment with grommets.

What causes Glue Ear?

In most cases glue ear is thought to be due to a problem with the Eustachian tube.

The Eustachian tube (the ET) is a tube which joins the Middle Ear Space to the back of the nose. It is normally closed but every time you swallow or yawn the tube opens, so normally it should be opening many times a day.

 

Every time it opens it does 2 things:

1. Allows air to pass into the middle ear space.

The middle ear space is lined with a lining called ‘mucosa’. Mucosa contains glands which continually produce a very thin film of mucus which covers the lining keeping it very slightly moist. Mucosa has to have a regular supply of air(oxygen)on its surface to remain in a healthy state. If it is deprived of oxygen then it becomes unhealthy which results in the glands swelling up and producing more mucus.

2. Equalizes the pressure.

The middle ear space is an enclosed space lined with a lining that has a rich supply of blood vessels running through it. The blood vessels absorb the air in the middle ear space. If you remove air from an enclosed space you develop a negative pressure. For example if you seal a bicycle pump over the end of a paper bag and pull the plunger out you are removing air and creating a ‘negative pressure’ which causes the paper bag to collapse. The walls of the middle ear space are hard (apart from the ear drum) so do not collapse but any negative pressure draws fluid into the middle ear space. Because the ET is opening all the time air is continually entering the middle ear space so the pressure stays the same as the outside world.

If the ET doesn’t work, in other words it doesn’t open as often as it should, then the lining of the middle ear becomes unhealthy and produces more mucus and a negative middle ear pressure develops which draws the mucus into the middle ear space. The middle ear space fills with mucus and you have developed glue ear.

What causes problems with the Eustachian Tube?

Being a child

Glue ear can occur at any age but is much more common in children especially around the ages or 2-6 yrs old. Children’s Eustachian Tubes(ET) often don’t work very well so they are more prone to episodes of glue ear. These can be short lived ie weeks to months or sometimes last for months to years. As they grow the ET function improves and most children will grow out of their glue ear.

 A cold

The lining of the ET is continuous with the lining of the nose. When you get a cold the virus infects the lining of the nose and sometimes the ET lining can also be affected and swell and become blocked. This usually resolves once the cold settles but sometimes can take weeks to months or even longer.

Allergies

As with a cold the thing you are allergic to can irritate the ET lining as well as the nose lining and cause it to swell and block.

Sinusitis

If you have sinusitis infected mucus from the sinuses can flow over the openings of the ETs irritating the lining and causing it to swell and possibly block the ET.

Air travel / Diving

 As you go down in an airplane or when diving the outside pressure increases. If your ET does not open then the pressure in the middle ear space becomes negative. This negative pressure can hold the walls of the ET closed making more difficult to equalize. As the negative pressure increases it starts to suck the ear drum inwards. This is what causes the pain people sometimes experience on airplanes during descent or when diving if they can not equalize. This situation may sometimes lead to fluid collecting in the middle ear space. This is known as a ‘barotrauma’.

In adults – A tumour (rare)

Tumours in the back of the nose are rare. However if a tumour grows in the confined space where the ETs open then it may block one of the tubes leading to a one sided glue ear. For this reason it is important to examine the back of the nose in an adult who presents with a one sided glue ear.

Adenoids

Adenoids are lumps of what’s known as ‘lymphoid tissue’ , like tonsils, which are situated at the back of the nose between the openings of the ETs. If the adenoids are very large they may block the ETs and stop them form opening effectively.

What are the effects of Glue Ear?

Glue ear may cause the following problems:

No symptoms

Some children may have glue ear which is found by chance and causes them no problems and will probably resolve spontaneously.

Speech delay / Behavioural problems

If hearing loss is significant and prolonged it may interfere with speech development. Also poor hearing may lead to behavioural problems.

Deafness

Glue can cause hearing loss which can be very mild or very significant.

Recurrent ear infections

Recurrent ear infections are common in children. Sometimes the infections may be related to glue ear. If the infections are frequent then treatment options include longterm antibiotics or grommets. Grommets will often help either by stopping the infections altogether or by making and future infections easier for the child to tolerate because and pus comes out through the grommet and does not build up behind an intact ear drum which causes the pain associated with an infection.

Retracted ear drum (an ear drum that has been sucked inwards)

Sometimes the ear drum may get sucked inwards and touch the hearing bones. If this happens there is a small risk of the hearing bones being damaged. Occasionally the ear drum may get sucked in so far that it disappears out of view and the patient is at risk of developing a condition called a cholesteatoma, where a skin cyst forms deep in the ear and mastoid bone.

How is Glue Ear treated?

NoTreatment

The majority of children seen with glue ear for the first time will get better within about 3 months so the first option is to wait and watch. During this time if the hearing is reduced make sure you face your child when you speak to the and speak clearly and slowly. Inform teachers that the child should sit at the front of the class

Glue ear only need treating if it is causing problems such as:

Deafness

Speech Delay and or Behavioural problems

Recurrent Ear Infections

Grommets

Collapse of the ear drum – known as a retraction pocket.

Medication – If you have nasal congestion due to a nasal allergy then using steroid nasal sprays may help. Antibiotics, antihistamines and decongestants do not cure glue ear.

Reinsufflation – There are a couple of devices which attempt to blow air up the Eustachian tube in order to try and open the tube, equalise the pressure behind the ear drum and allow air in behind the eardrum.

The Otovent – The Ear Popper.

Adeoidectomy – If the child has problems with significant nasal obstruction due to enlarged adenoids then removing the adenoids may reduce the chances of the glue ear coming back.

Hearing Aids – If the only problem is hearing loss then Hearing Aids are one of the possible solutions. These would be worn until the glue ear hopefully clears itself as the child grows. They can be very effective if the child can get on with wearing them but obviously the childs hearing ability will drop when the hearing aids are taken out such as bath time, swimming and bedtime.

Adeoidectomy – If the child has problems with significant nasal obstruction due to enlarged adenoids then removing the adenoids may reduce the chances of the glue ear coming back.

More information coming soon

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