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.
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 an
operation called a myringotomy.
A
myringotomy 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.
Myringotomy
Procedures
A small
incision is made in the ear drum. Pus
and detrius from the middle ear are
sucked out of the middle ear chamber
with a special instrument and the
eardrum is cleaned with an antibiotic
solution. Then a small ventilation drain known as a grommet
is inserted into the
incision in the ear drum. The grommet
looks like a small tube with one end
inside the middle ear chamber and the
other end outside the ear drum. It is
made of either stainless steel or
plastic. Once the grommet is
inserted it allows both air into the
middle ear space and fluid in the middle ear
to drain away.
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|
Plastic
grommet to drain middle ear fluids |
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.
