Glue Ear and the use of Grommets in Children
This article is targeted to parents who have children with middle ear problems.
For burst eardrum problems please click
hear
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
- Headaches
- Fever
- Listlessness
- 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.

Common colds often cause otitis media,
simply because the swollen mucous membranes such
as swollen adenoids block the outlet from the
Eustachian tube, or because micro organisms
migrate from the back of the throat through the
Eustachion tube to cause infection in
the middle ear.
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.
Burst Eardrum
If the material
in the middle ear
cavity remains there and becomes infected the
consequential bacterial waste
may build up too fast for either 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 on
Burst Eardrum in children.
Treatment for Otitis
Media and 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.
- The second treatment is if there is a suspected infection.
If the eardrum has burst, this is usually
the case. Antibiotics are sometimes prescribed,
often initially by injection, then a regimen orally three times a day for at least 7 days.
****However,
before you ask a pediatrician or family
doctor for antibiotics, you may want to
read the latest from the American Academy of
Pediatrics
Another factor in
considering antibiotics is that in the past, penicillin, erythrosine, or erythromycin were prescribed. However, in the last few decades, many in the general population have become immune to the effects of these antibiotics, and stronger ones are often prescribed.
(The cause of immunity is often blamed on antibiotics fed to the food supply (chickens and beef) before they are brought to market.
)
If your child continues to have problems, your doctor may decide to refer them to an ear, nose and throat (ENT) specialist.
Surgical
Treatments for Continual Glue Ear with no Burst
Ear Drum
Surgical treatment using grommets
(Myringotomy)
If your child has had glue ear
and a low grade fever with earaches over a few months
and the eardrum has not burst and antibiotics have not worked, the other option is to have a small ventilation drain known as a grommet inserted into the
ear drum. The grommet is made of either
stainless steel or plastic. This procedure involves making a small hole in the eardrum and inserting the grommet through the hole
to keep it open. Initially fluid is sucked out of the middle ear through this hole
by your ENT, then once the grommet is
inserted it allows air into the middle ear space and lets fluid in the middle ear drain away.
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Plastic
grommet to drain middle ear fluids |
This procedure is known as a myringotomy. It is carried out under a short general anesthetic and takes about 15 minutes. Your child will usually be allowed to go home the same day.
What happens to the grommet
in the eardrum?
The grommet slowly moves outwards as the eardrum grows,
usually 9 - 12 months. It is then naturally pushed out of the eardrum into the outer part of the ear. It moves outwards with earwax until it falls out of the ear canal, often unnoticed.
They can also easily be removed at a follow-up ENT appointment.
Over half of children who have grommets do not need further surgical treatment as they get older. However, 30% of children will need grommets inserted a number of times until their glue ear
condition improves. Although the eardrum is tough, repeated grommet insertions may eventually scar it, which can sometimes cause a hearing loss
as the scar tissue makes the ear drum less
resilient i.e. less able to vibrate.
Looking after a child with grommets
The hole in the eardrum for grommet insertion is small, however, it is worth taking a few simple precautions to stop water getting into your child's ear:
- Your child should swim on the surface of the water only and not dive.
- Use earplugs or cotton wool with Vaseline to stop soap water getting into the ears when showering or washing their hair.
Flying is actually easier for a child with a grommet. The grommet allows air in and out of the ear
as air pressure changes. However, children who have a history of frequent ear infections or have had grommets in the past (but no longer have them) are occasionally at risk of perforation of the eardrum when flying. If you are worried about this, ask your doctor.
About 5% of children with grommets get an ear discharge at some time, often after a cold. This is usually not serious or painful, but it is important to keep your child's ears clean and to consult your doctor as soon as possible. Your doctor will usually prescribe antibiotics or eardrops.
If your child gets a lot of discharge, gently clean their ears using a twist of clean cotton wool or a very soft cloth.
Never use a cotton-tipped ear cleaning stick as you may go too far into the ear and cause damage. If infections are treated quickly, the ears will get back to normal with the grommets in place in most children.
Other surgical treatment for glue ear
Other surgical treatment for glue ear involves an 'adenoidectomy' or surgical removal of the adenoids. The adenoids are located above the tonsils, at the back of the throat
and are thought to assist the body in its
defense against incoming bacteria and viruses by
helping the body to form antibodies. With ear infections, the adenoids often swell, usually due to an infection in the immediate area, in this case, the middle ear. However, the reverse is also true. If there is an infection in the throat and the tonsils and adenoids swell, they can sometimes cause a middle or inner ear infection.
Adenoids get larger between birth and four years of age and then become progressively smaller. By adulthood they have disappeared altogether.
An adenoidectomy is commonly carried out in children over the age of three and is thought to help stop a child from getting glue ear again. Removing their adenoids does not harm a child. Adenoids are removed through the mouth under general anesthetic and the child is usually allowed to go home the same day.
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.
- 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
- allergies
Stress
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).
Bottle feeding
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.
© 2008 Hearing Central LLC
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