What Is Glue Ear?

Overview

As you may already know, your ear is made up of three parts. The outer ear includes the visible part and the canal, the middle ear which begins with the eardrum, housing the 3 tiny bones known as ear ossicles, and the inner ear.

Glue ear, also known as otitis media with effusion or adhesive otitis, refers to a condition where there is a build-up of fluid in the middle ear. The fluid usually presents as a mucoid secretion at first, then eventually gets thicker and sticker, hence the name, glue ear.

When this sticky fluid blocks the middle ear, it becomes difficult for sound waves to pass through to the inner ear, hence making it hard to detect quieter sounds. 

This ear condition is predominant in young children less than 6 years old. This can be attributed to the fact that a child has a flatter and smaller Eustachian tube. Regardless, glue ear can occur at any age.

How do our ears work?

When sound waves travel from the outer ear into the ear canal, they hit the eardrum, making it vibrate. The waves (now vibrations) pass through the middle ear, get amplified by the ear ossicles, and are further sent to the inner ear. On getting to the inner ear which is filled with fluid, the cochlea then converts the vibrations to electric signals that are transmitted to the brain via the auditory nerves. Then, the brain immediately interprets these signals as sound.

This whole process happens within the blink of an eye and you are unconscious of it.¹

Now, the middle ear connects to the back of the nose down to the throat through a thin channel known as the Eustachian tube.² This tube has two functions basically;

• To drain fluid and other debris out of the ear
• To let in air into the middle ear space, helping to regulate the normal air pressure in the ear. This also helps prevent sudden changes in air pressure which can harm the ears

The presence of air in the middle ear makes it possible for you to hear properly. So the Eustachian tube makes sure that air is let into the ear while any fluid that accidentally enters the ear, maybe while eating or yawning, is removed.

Causes of glue ear

Remember that your Eustachian tube is responsible for removing excess fluid in the middle ear. Sometimes, there are situations where this tube gets blocked or is unable to open properly. This is often seen in young children because their Eustachian tube is narrower than that of an adult and more likely to get obstructed.

Such situations include:

• Respiratory tract infection: could be either of a bacterial origin like sinusitis or of viral origin such as common cold, sore throat, and the flu
• Breastfeeding while lying down: such a breastfeeding posture may cause fluids to escape into the eustachian tube
• Medical conditions such as Down Syndrome and Cleft palate
• Increased air pressure in the ears (flying or diving)
• Severe allergies
• Swollen adenoids 
• Other irritants such as passive cigarette smoke

Glue ear could also occur following ear infections such as an acute episode of otitis media.⁷

Signs and symptoms of glue ear

Temporary hearing loss:

This is the most common symptom and often affects both ears.³ It is also regarded as dulled hearing because the child’s hearing loss is usually mild. A child with this symptom often has difficulty hearing sounds at normal volume and from far away. They also talk louder than usual and ask people to repeat themselves when spoken to.

The severity of hearing loss may vary from one child to the other and is dependent on the thickness of fluid in the ear.

On a few occasions, the hearing loss may become prolonged, causing a delay in a child’s speech and language development. And when it persists for more than a few months, it can lead to permanent and severe hearing loss.

Earache or mild to moderate ear pain:

Pain is not a major symptom, one can experience pain especially if an ear infection triggers the condition.

Other symptoms to watch out for in your child include:

• Appearing often tired and irritable because they have to work harder to hear sounds
• Become quiet, withdrawn, and shy away from social activities 
• Complains of a ringing or buzzing noise in their ears (tinnitus) 
• Difficulty in engaging in conversations in places with background noise
• Lacks concentration, is easily distracted, and doesn't respond when called

Management and treatment for glue ear

In most cases, glue ear is self-limiting, i.e., it goes away without requiring treatment. However, your health provider may observe you for three months (active monitoring) to ensure that there are no complications. When the symptoms persist after 3 months or more, the following treatment options are considered:

Antibiotics:

This is recommended when the glue ear is associated with pain in which case otitis media or an associated middle ear infection is suspected

Autoinflation^:6

Involves unblocking the Eustachian tube and draining the fluid in the middle ear. It is a procedure that raises the pressure in the nose and is done by either of the following methods.

1.  Blowing up a balloon with one nostril in succession. As the balloon deflates, the air is blown into the nose, and the child is prompted to swallow. This process can also be achieved with an air pump device⁴
2. Forced exhalation or swallowing with both nostrils closed.

This procedure is a good way of letting air into the middle ear while draining the excess fluid. A study done by Williamson and colleagues in children aged 4 to 11 years showed improvement at 3 months by this method⁵

Auto inflation can be performed several times a day and is not recommended for a child under 3

Hearing Aids:

These are temporary devices that make sounds louder and improve your ability to hear them. The doctor may recommend a hearing aid for use while you are waiting for the condition to resolve

Myringotomy:

Sometimes, the doctor may decide to perform a minor operation where he makes a small incision in the child’s eardrum to enable fluid to flush out from the ear. Then he places a little hollow ventilation tube known as a grommet in the cut which allows the incised membrane to remain open and regulate the pressure in the ear. Grommet insertion helps to prevent further build-up of fluid by allowing air to move into the middle ear. The small tube often remains in the ear from 6 months to 1 year, falling out on its own after the eardrum has healed.

This procedure also enables the instillation of antibiotic ear drops in cases of ear infections, facilitating faster recovery.

This is a short operation that doesn’t require you to spend more than a day in the hospital.

You might notice a discharge coming out from the eardrum for a few days immediately after the operation. This is normal but should be reported to your doctor if it becomes prolonged

Adenoidectomy:

This is employed when the glue ear is caused by enlarged adenoids. Adenoids are lymph tissues that are located at the back of your nose and connected to the root of the Eustachian tube. An inflamed adenoid can lead to a buildup of fluid in the Eustachian tube, resulting in a glue ear. This procedure involves carrying out surgery to remove the inflamed adenoids. It is often done alongside myringotomy.

Facial plastic surgery:

Doctors may recommend facial plastic surgery for children with a cleft palate to reduce the chances of developing glue ears

Diagnosis

Your primary health provider can examine your child’s ear using a small scope that has a light and magnifying glass attached to it. He checks for the presence of fluid and determines if there are further complications.

He can refer you to see an ENT specialist if the glue ear has persisted for more than 3 months. Further assessments include running a tympanometry test which provides information on the presence of fluid and mobility of the eardrum.

A hearing test is also carried out to confirm the severity of hearing loss.

FAQs

How can I prevent glue ears?

The easiest way to prevent glue ear is by reducing the chances of ear infection. This can be done by washing and disinfecting the hands frequently, avoiding exposure to cigarette smoke, breastfeeding in an upright position, etc. Ear wax doesn't cause glue ears.

How common is glue ear?

Glue ear is very common among young children. It affects at least 80% of children between 9 months to 6 years of age.

Who is at risk of glue ears?

Although adults develop glue ears on a few occasions, children are more at risk of this condition. This may be because their Eustachian tube is narrower and flatter.

How long does glue ear last?

Glue ear often lasts for as long as 3 months. Persistent glue ear after 3 months might indicate other complications.

When should I see a doctor?

You should see a doctor when your glue ear doesn't resolve after 3 months, or when the symptoms affect your child’s speech, learning, and development.

Also, according to the National Deaf Children’s Society, a child with Down’s syndrome or cleft palate should see a doctor as soon as he develops symptoms. 

Summary

Since glue ear is commonly seen in children, their diet and hygiene must be given utmost priority. Any changes in behaviour such as withdrawing from social activities or not responding when called should be noted. The good part is that the symptoms go away and the child returns to normal when the glue ear is resolved.