Glue Ear in Children
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The ear drum is a very thin porous membrane, thin enough for liquids in the middle ear to leak through into the ear canal if the pressure is great enough.
The medical term for glue ear is otitis media with effusion - a condition in which a sticky glue-like fluid builds up in the middle ear chamber and leaks into the ear canal. It is a very common condition that affects mainly young children aged between two and five years. In most children, glue ear clears up on its own. However, up to 5% of children get persistent glue ear, which if left untreated, can cause long term hearing loss. Physicians call glue ear 'otitis media with effusion', 'secretory otitis media' or 'chronic secretory otitis media'.
Glue Ear is not a disorder in itself; it is just a visible symptom of a discharge from the middle ear. When the white sticky liquid mixes with the normal ear wax in the ear canal, it changes to a thick gluey orange color.
Note: Glue ear is sometimes confused by anxious parents with the normal discharge of wax from a child's ear canal. During an infant or child's growth, there may be periods when ear wax is produced more copiously than normal, causing wax to leak from the ear.
How to tell the difference:
- If the child has not had a fever then it is probably excessive wax discharge
- If the child has not complained of an earache then it is probably an excessive wax discharge
- If the discharge does not have a really smelly odor then it is probably an excessive wax discharge (there is a slight odor to normal wax)
Symptoms of Glue Ear
The usual symptoms of glue ear are:
- A thick whitish liquid discharge from the ear that changes to orange when it mixes with ear wax
- Ear aches
- The child may be clumsy. With very small infants (1-3 years old), it might also take them longer to start to walk, speak or understand language.
- Older children may be able to tell you if they cannot hear very well. Or you may notice that they say 'pardon' or 'what' a lot or that they turn the television up loud. Glue ear also makes older children clumsy and dizzy.
Direct Causes of Glue Ear
Usually the Eustachion tube is the culprit causing glue ear. The middle ear needs to be full of air to let the eardrum and three small small bones (ossicles) vibrate freely to transmit sound from the ear drum to the inner ear. The Eustachian tube regulates air pressure in the middle ear and drains the natural secretion from the middle ear to the back of the throat The Eustachian tube is closed for 95% of the time and only opens when swallowing or yawning. Its main purpose is to keep the air pressure in the middle ear the same as the outside air pressure.
The lining of the middle ear is similar to that in the lungs in that air is absorbed through outer lining of the middle ear and into the bloodstream. This means that unless the Eustachian tube opens properly to balance the air pressure, you eventually lose air from the middle ear space .
Children have a narrow Eustachian tube, often hindering it from opening properly. This can lead to a vacuum in the middle ear. Once this vacuum forms, the lining of the middle ear becomes inflamed and swollen. As part of the inflammation reaction, a thin sticky fluid seeps out from this lining into the middle ear space. If the Eustachian tube is blocked, this secretion has nowhere to go. The fluid then becomes thicker preventing the eardrum and small bones (ossicles) from vibrating. Unless the ossicles can vibrate, no vibrations get from the ear drum to the inner ear receptor (cochlea).
As the secretion fills up the inner ear cavity, it begins to put pressure on the eardrum and the eardrum will bulge out under the pressure. The ear drum is porous enough that some of the liquid will seep through to the ear canal until the pressure is relieved within the middle ear cavity. This stage is usually accompanied by ear aches, headaches, and fever.
Problems if the Eustachian tube does not open
If the waste material in the middle ear cavity remains there there is a high probability it will become infected. This infection is known as Otitis Media. As bacteria grows in the dark, damp space, the bacterial waste may build up too fast for the Eustachion tube to drain it or for the ear drum to pass it through. The resultant pressure may burst the eardrum leaving a tear in the ear drum. This is actually a positive event. The burst eardrum will immediately relieve the pressure in the middle ear and the accompanying earache will diminish. Your child will stop screaming :). More information onBurst Eardrum in children.
Treatment for Glue Ear
The treatment your doctor (family or pediatrician) offers for glue ear will depend on how long your child has had glue ear and the number of prior incidents of glue ear
There are three methods of treatment for glue ear:
- Many children recover from glue ear if the Eustachian tube re-opens on its own. Doctors usually adopt a wait-and-see approach to begin with. Your child will normally be observed for about three weeks to see if they need further treatment. If the eardrum has burst, it should heal over time (3-6 weeks)
- As a parent, self medication can be performed on your child by obtaining an OTC (Over The Counter) pediatric oral decongestant to thin the fluid in the ear and reduce the Eustachion tube swelling, causing the fluid to drain into the throat. If that does not work you might want to try a small dose of an antihistamine such as Benadryl™. Have your pharmacist recommend a child's dosage. If that treatment still doesn't work after one week, see your family doctor or physician. They might prescribe stronger antihistamines or nasal steroids in the form of drops or sprays - both of which will help reduce the swelling of the Eustachian tube.
- Have an operation called a myringoplasty to insert grommets
How you can help your child with glue ear
If your child has glue ear condition, you can do a number of things to help:
- Make sure your child has been properly assessed by your doctor who may refer you to an ENT specialist for a myringoplasty.
- If you suspect that an allergy is causing glue ear, ask the ENT specialist about this.
- Avoid smoking near your child.
While waiting to see if glue ear clears up on its own or waiting for grommet surgery, children sometimes have reduced hearing for quite some time and will need help with communication. During this time, they may need to use a hearing aid and have support at home and school. Here are some ways in which you can make communication easier with your child:
- Reduce background noise when talking to your child, for example turn down the television.
- Attract their attention before you start speaking to them.
- Put your head at their level. Do not shout.
- Speak clearly. Do not exaggerate mouth movements.
- Let family and teachers know about the problem.
- Remember that glue ear usually stops being a problem well before puberty.
Predisposition factors for Otitis Media and Glue Ear
There are factors that can increase the risk of a child being susceptible to otitis media and glue ear:
- being a male
- short length of breastfeeding
- attendance at day care centers
- parental smoking
- wet climate
- winter season
- upper respiratory infection
- housing with mold
Many children suffer from stress today. Modern children spend many hours in day care institutions with a high noise level and limited space. Another stress inducing factor can be the changed social pattern, where many children live with a single divorced parent. Stressed parents may also transmit some of the stress to their children. Stress causes the immune system to deteriorate, and opportunistic infections take advantage of children with low immune resistance.
Allergy and otitis media
The role of allergy as one of the major cause of otitis media has been firmly established in the medical literature. Most of the children are allergic to food or inhalants or both. The mucous membranes are particularly affected by milk allergy. Allergic reactions cause blockage of the Eustachian tube by two mechanisms:
- Inflammatory swelling of the tube, and inflammatory swelling of the nose, causing the Toynbee phenomenon (swallowing when both mouth and nose are closed, forcing air and secretions into the middle ear). One illustrative study of 153 children with ear aches demonstrated that 93,3% of the children were allergic to foods, inhalants or both (Mc. Mahan 1981).
Recurrent ear infection is strongly associated with early bottle feeding, while breastfeeding of minimum 6 month has a protective effect. Whether this is because of cow's milk intolerance or the protective effect of mother's milk against infection has not yet been proven. It is probably a combination of both. Another fact is, that it is not a good idea to bottle feed a child lying on her back, as it may lead to regurgitation of the bottles contents into the middle ear.