Glue Ear

Glue ear is a fairly common condition in which the middle ear is filled with fluid instead of air. This condition predominantly can affect one or both ears. It is also known as otitis media with effusion, middle ear effusion or serous otitis media.

What is glue ear?

Glue ear occurs when the middle ear is filled with sticky glue like fluid or serous fluid, instead of air. This fluid dampens the normal vibrations leading to symptoms of diminished hearing.

How common is glue ear?

It is common in preschool children of 6 months to 4 years old.

By ten years of age, eight out of ten children have had at least one episode of O.M.E. (otitis media with effusion).

It is more common during winter months and in children living in daycare or homes where people smoke.

Symptoms:

The main symptom associated with glue ear is diminished hearing which may range from slight muffle to moderate loss in hearing. 

Other ways of presentation of this condition may be:

  • Problems of speech and language
  • Abnormal social behavior
  •  Tinnitus (ringing in the ear)
  •  Balance disorder
  •  Selective hearing
  • Turning up the volume of TV or radio
  • Episodes of mild ear pain
  •  Irritability
  • Feeling of fullness in the ear
  • Problems of school performance

Causes:

The major underlying cause of glue ear is because of Eustachian tube dysfunction.  The Eustachian tubes function to maintain air filled middle ear cavity.  If the Eustachian tubes are blocked, narrow, patulous, or not performing its normal function, middle ear air gets absorbed and filled with serous or thick glue like fluid.

 Children may develop this condition secondary to:

  • Cold
  • Nasal allergy
  • Sinusitis
  • Gastroesophageal reflux
  • Hypertrophied adenoids and tonsils where they act as a source of infection. 
  • Other congenital abnormalities such as Down’s syndrome and cleft palate are contributory factors.

Diagnosis:

A thorough history and clinical examination are of utmost importance.

Otoscopic examination of ears is done to see the condition of the ear drum.

Tympanometry is the choice of test to confirm or exclude glue ear.

 Audiometry is done to assess the severity of hearing loss.

Management: 

Endoscopy and x-rays are done if a source of infection is suspected.  Treatment is to remove the underlying cause if possible.

Medical treatment with antibiotics, antihistamines, nasal decongestants, oral steroids may benefit in a few cases

Active observation” or “watchful waiting”: Generally the fluid will resolve with conservative management or goes away by itself with time.

Surgical management is required for children with persisting fluid in the middle ear.

This would involve insertion of ventilation tubes (grommets) in the ear.

In case a source of infection such a hypertrophied adenoids or chronic tonsillitis is suspected they can be operated in the same sitting.