GLUE EAR AND GROMMETS

These are all terms that are used to describe fluid building up behind the ear drum. It is probably the commonest condition to affect children although it does sometimes affect adults also. 

It happens when the tubes (eustachian tubes) that drain the ear get blocked. (See next section)

Glue ear symptoms can vary from person to person. It can have minimal or no symptoms, or cause the following:

• Hearing loss / muffled hearing
• Not responding when called
• Mild ear ache
• Changes in behaviour
• Lack of concentration
• Imbalance
• Pressure or fullness of the ear
• Noises or ringing in the ear (a form of tinnitus)
• Popping or clicking noises
• It is important to seek medical advice when these symptoms occur.

See the diagram below showing you the drainage tube of the ear, the eustachian tube. It is narrower and flatter in children and so more prone to blockage, which is why children have this problem more often than teenagers and adults. Fluid and secretions are produced by the lining of the ear (middle ear). If the eustachian tube is blocked, fluid builds up causing the problems already discussed. The trapped fluid can also get infected leading to ear infections and a condition called acute otitis media. Your child will be unwell with a temperature and severe pain. The ear drum may burst and allow the infection to drain out which you will see coming out of the ear. This normally settles on its own and the ear drum should heal within a few weeks, if not days. Repeated episodes however requires a check up from an ENT doctor.

The eustachian tubes can be blocked due to several reasons;

• A recent cold or cough
• Allergies
• Exposure to smoking

If your child was born with a cleft palate or a genetic condition such as Down’s syndrome, this makes it more likely to develop glue ear.

Glue ear symptoms can vary from person to person. It can have minimal or no symptoms, or cause the following:

• Hearing loss / muffled hearing
• Not responding when called
• Pain in the ears to certain sounds
• Mild ear ache
• Changes in behaviour
• Lack of concentration
• Imbalance
• Pressure or fullness of the ear
• Noises or ringing in the ear (a form of tinnitus)
• Popping or clicking noises

It is important to seek medical advice when these symptoms occur.

Firstly, the option for conservative management (or watchful waiting) is always available if you or your child have minimal symptoms. This should be performed for 3 months from the time you see an ENT surgeon as at least half of cases will clear up in that time. Sometimes waiting for 3 months is not appropriate.  I will come on to this later…

For children, the two treatments that are available are grommet insertion, or the use of a hearing aid. 

Grommet insertion is one of the commonest procedures performed in children. It is also commonly performed in adults. Most parents would choose this treatment for their child to treat glue ear that hasn’t resolved on it’s own.

The idea is simple; a hole is made in the ear drum and a tube (usually made of plastic) is placed within the hole to keep it open. This allows air to move in and out of the middle ear and stops more fluid building up. The procedure can be undertaken while awake, and under local anaesthetic if you are an adult; or in children under a short general anaesthetic. Click here to learn more about grommet surgery itself and what to expect.

If the only symptom is of reduced hearing then a hearing aid may work just fine. The up side of a hearing aid is that a procedure is avoided. The down side is that it doesn’t provide natural hearing and requires retuning of the hearing aids when the amount of fluid in the ears changes. It also causes a blockage effect within the ear due to the ear piece that goes into the ear canal and can be irritating to the ear canal. Certain sounds can also be uncomfortable. You can see that I’m not a huge fan of hearing aids, however for some, this will be the better option. This is the case if a grommet insertion procedure is not possible or recommended by the treating ENT surgeon (there are reasons for this in people with certain conditions). It is therefore important that the fitting is and provision of hearing aids are by an experienced team. My team of audiologists that I work very closely with are experts in this and provide the latest in hearing aid technology. They have worked in the NHS and private sector for decades.

Conservative management or watchful waiting involves a few important points:

Being aware that there is a degree of hearing loss is essential. Informing school teachers about it so that your child may sit at the front of the class will help. Exploring for more help from the school while your child has hearing loss is also worthwhile.

Using an Otovent device while you wait has also shown to help (see picture below). This is essentially a balloon that is blown up through the nostril. The process of doing this forces air up the eustachian tubes into the middle ear and opens it up. Adults or older children can instead do this without a balloon, and is called the Valsalva manoeuvre. Simply pinch your nose tightly, close your mouth, and try and blow out through your closed lips. Divers do this when descending down into deep water so that they can equalise the air pressure in their ears. Some of you might have tried this when flying to avoid the pain and pressure when taking off or landing in an airplane. Essentially the same problem is occurring when on a plane as the eustachian tube closes easily due to the changes in air pressure and can be difficult to reopen. 

The use of antihistamines, anti-allergy medication, steroids, acupuncture, probiotics, homeopathy, cranial osteopathy, changing the diet does not work in my opinion. If there is good evidence to suggest that there is nasal allergy then it may be worth trying anti-allergy medication. In adults improving the nasal airflow can sometimes help and I will discuss this with you if appropriate.

Grommet surgery is a day case procedure, without the need to stay overnight. If under a general anaesthetic, you will also be seen by an experienced children’s anaesthetist who will safely provide the anaesthetic.  The patient lies on their back with the head turned to the side, and a speculum is placed in the ear. A microscope is used to look at the ear drum and a carefully placed cut is made. The grommet (ventilation tube) is then placed into the ear drum to stop it from closing. In most cases it is a straight forward procedure but in very young children, or in narrow ear canals an experienced surgeon who has worked in dedicated children’s hospitals like myself is advisable. 

You are advised to keep the ear dry for 2 weeks by not letting water get into the ear. After that you can forget that they are there! A few children and adults can be prone to infections and if this is the case, I would advise avoiding diving down into water when swimming. Use earplugs and a covering headband and be careful when washing hair with soapy water as it can seep into the ear more easily than non-soapy water.

I will need to see you a few weeks after surgery to check the ears. A grommet lasts for roughly 9 to 12 months if it is a short term one. Some grommets can last for a few years and depends on the material it is made from as well as the shape. Most are fitted with short term grommets and only a few require repeat grommet insertion.  

Click here to go to the grommet information leaflet.