Glue Ear (otitis media with effusion)

Glue ear also known as otitis media with effusion is a build-up of fluid/mucus in the middle ear behind the ear drum. Normally the middle ear contains air. Although glue ear is common in children it can occasionally occur in adults.

Glue ear may cause no noticeable symptoms. In some it may cause hearing loss. This may vary from mild to moderate hearing loss. The severity of hearing loss can fluctuate from week to week or month to month. Some children may experience earache. Some children may experience mild clumsiness or balance problems. Glue ear is diagnosed by assessments of hearing, tympanogram (a test to assess how easily the ear drum moves) and looking at the ear drum.

The middle ear often becomes infected in young children. This usually resolves completely but occasionally after the infection has gone some fluid remains in the middle ear (glue ear). Enlarged adenoids can also cause glue ear. Other factors which make glue ear more likely are: exposure to tobacco smoke (passive smoking), family history of glue ear, attendance at a nursery and repeated colds and flu. Glue ear is also more common in conditions such as Down’s syndrome and cleft palate. In adults can develop glue ear after a cold or flu. Other causes include nasal allergy, nasal polyps and occasionally serious problems such as vasculitis or nasopharyngeal cancer. It is important therefore that the back of the nose is examined in adults developing glue ear.

Treatment options include:

Watch and wait

In most people glue ear will resolve after three months.

Nasal Balloon (Otovent®) or EarPopper®

This is a special device which the patient blows into using her or his nose. This is done three times a day for 6 weeks. Such a device can be bought from chemists or the internet (e.g. Otovent®). The treatment may work better if you can swallow while the balloon is inflated. See video below. The Otovent® device is available on the NHS with a prescription or can be bought over the internet (e.g. on Amazon ). The response to this treatment is variable although there is some evidence it can provide some benefit. An alternative device is the EarPopper® device which has a battery operated pump which blows the air in to the nose while you are swallowing. Is is more expensive.

Inserting grommets

A small (2-3mm) hole is made in the drum and a grommet (small plastic tubes) are placed in the ear drum after the fluid is drained. The grommet allows air to enter the middle ear and so helps the glue ear to resolve. They do not cure the underlying problem but bypass it. The Grommets come out of the ear drum by themselves after 6 to 18 months. On occasions the glue ear may come back and grommets may have to be inserted again. In the case of a child they will in most cases “grown out of the problem”. In adults it is an option to drain the fluid/glue ear via a small hole in the ear drum under a local anaesthetic in clinic without inserting grommets. This, combined with a short course of steroid treatment, can be successful in treating the glue ear.

Adenoidectomy

Adenoid are glandular tissue art the back of the nose next to the Eustachian tube which connects the nose to the ear. If the adenoids are enlarged or diseased they can make glue ear more likely. Their removal can help prevent and treat glue ear. See patient information sheet on adenoidectomy.

Hearing Aids. In some children the hearing can be improved with hearing aids. However as the hearing can fluctuate hearing aids are not always effective. Hearing aids are usually considered in some circumstances e.g. if past grommets have not worked or in patients with cleft palate or Down’s Syndrome.

The Grommets Operation

The operation is carried out under general anaesthetic. A hole is made in the ear drum, the fluid is drained and a plastic grommet placed in the hole. The operation is not particularly painful. Occasionally a small amount of blood stained fluid comes out of the ear immediately after the operation. This always stops and is not anything to worry about. Most patients can go home the same day of surgery. Occasionally adenoidectomy and/or tonsillectomy may also be performed.

Infection

The grommets can become infected and there may be a discharge from the ear. This can usually be treated effectively with ear drops such as Sofradex or Gentisone HC. (Three drops three times a day for 5 days, try to squelch the drops deep into the ear by squeezing the outer ear canal.)

Perforation

On rare occasions once the grommet comes out, the hole may not heal resulting in a perforation of the ear drum. This may become infected and may require a separate operation to correct.

Blocked grommet. Occasionally grommets can get blocked resulting in return of the glue ear. Sometimes the grommet can be unblocked by using bicarbonate ear drops.

After Grommets

The child can resume normal activates the day following surgery (unless they have had adenoidectomy or tonsillectomy). The child can return to school the following day.

Usually the child is seen in clinic at 6 to 12 weeks after the operation to check the hearing is OK and there has been no problems.

When swimming there is no need to wear earplugs. However avoid diving into the swimming pool head first or swimming more than 3 foot underneath the surface. When taking a shower or bath keep the head tilted down to prevent water entering the ear. If you wish to be particularly careful smear some cotton wool with petroleum jelly/Vaseline and place it in the ear to water proof it while having a shower or bath. Soapy water can get into the ear and through the grommet more easily than non-soapy water.

Grommets usually come out within 18 months. They can come out without you noticing them. Occasionally they can fall out much earlier or stay in longer. After two years if you’re not sure the Grommets have fallen out please ask your GP to check. If they’re still in place ask the GP to refer you back for consideration of removal.

After the Grommet fall out glue ear can recur and further grommet insertion may be necessary.

Otovent treatment for Glue Ear / Eustachian Tube Obstruction

Glue ear treatment with endoscopic grommet insertion (thick glue)

Right endoscopic myringotmy & drainage of glue ear