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
- 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.
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 on
Burst 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
- 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.
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