Glue ear is one of the most common childhood illnesses. Children under the age of five are the largest group affected, though for some it can persist into adolescence. Some adults may also be affected.
For ears to work properly the middle ear needs to be kept full of air. The eustachian tube, which usually does this, runs from the middle ear to the back of the throat. In children this tube is not as vertical and wide as it will be when they get older and as a result doesn’t work as well.
If the eustachian tube becomes blocked, air cannot enter the middle ear. When this happens, the cells lining the middle ear begin to produce fluid. This can be like a runny liquid which can get thicker as it fills the middle ear. With fluid blocking the middle ear, it becomes harder for sound to pass through to the inner ear.
This can make quieter sounds difficult to hear. It can be like listening to the world with both fingers stuck in your ears. It’s hard work, try it for yourself!
Glue ear is often, but not always, linked with ear infections. However, it can sometimes develop unnoticed.
A prolonged period of time with reduced hearing can affect the way in which a child’s speech develops. Children with glue ear may also fall behind at school and become disruptive if they do not have extra support. Changes in behaviour, becoming tired and frustrated, lack of concentration, preferring to play alone and not responding when called may indicate glue ear.
What conditions influence glue ear?
There are many different things that can contribute to glue ear. These include colds and flu, allergies and passive smoking. Children with cleft lip and palate, or with genetic conditions, such as Down’s Syndrome, may be more likely to get glue ear as they may have smaller eustachian tubes.
What treatment is available?
Glue ear tends to get better by itself, but this can take a while. If the glue ear is not causing any major problems, a period of watchful waiting for about three months is often advisable. If glue ear is causing problems with poor hearing, poor speech or lots of infections, it may be better to put grommets in (see info sheet on Grommets).
Getting your child to blow up a special balloon with his or her nose can clear fluid in their ear and improve their hearing within a few weeks. But your child has to do this regularly, and young children can find the balloon hard to use, and sometimes painful!
Some doctors may use nose drops or nasal sprays to see if they help. The evidence for this however is limited.
A hearing aid can sometimes be used to treat the poor hearing and speech problems that are caused by glue ear. This would mean that your child would not need an operation and are an option for those in whom a general anaesthetic is a significant risk.
In the meantime how can I make hearing easier for my child?
Basic communication tips can help to make listening easier for your child. It is important to get your child’s attention before you start talking. Make sure you face your child as much as possible, and keep eye contact. Check that background noise is kept to a minimum. Speak clearly, without shouting and maintain your normal rhythm of speech.
The teacher or school nurse may realise that your child is having problems, but may not be aware that this is because of their hearing. It is important that you tell the teacher about your child’s hearing so that arrangements can be made in school to help. It is important that your child is able to sit near the teacher in the classroom, that they understand what is said and that they are not made to feel awkward about asking for things to be repeated.
What are Grommets?
These are tiny plastic tubes that are put in the eardrum. This is done during a short operation at hospital under general anaesthetic. The grommets are inserted after the fluid in the middle ear has been drained away. The grommets allow air to circulate in the middle ear and stop more fluid from building up.
Grommets are not a cure for glue ear. But they can clear the fluid inside your child's ears and improve their hearing until they grow out of it
How long do they work for?
Grommets usually stay in until the eardrum has healed and pushed them out. They tend to stay in for approximately a year, give or take a few months. You may not notice when they drop out! Periodic visits and examinations will check on the status of the Grommets and the hearing.
Eventually when the grommets fall out, the glue ear may come back. This happens to one child out of every three or four who has grommets put in. If this happens Grommets may need to be reinserted until your child grows out of the problem.
What about the adenoids?
There is evidence to show that taking out the adenoids at the same time as inserting Grommets may help prevent the glue ear recurring, and therefore it may be recommended that an adenoidectomy is performed at the same time as putting grommets in.
After the operation
Grommets are not usually sore at all, but each child is different. You can give your child painkillers if you need to. Grommets should improve your child’s hearing straight away. Some children think everything sounds too loud until they get used to having normal hearing again. This usually takes only a few days.
Your child should usually be able to go back to school or nursery the day after the operation.
What about ear infections?
It's not uncommon for children with grommets to have a discharge from their ear, often during or after a cold. This will mostly not be associated with any pain. About 1 in 6 children have fluid coming out of their ear, and a few (less than 1 in 25) have this for a long time. If you get some antibiotic ear drops from your doctor, the problem will quickly settle. Some doctors may give antibiotics by mouth instead of antibiotic ear drops.
Can my child swim with grommets in?
Your child can start swimming about a week after the operation, as long as they don’t dive under the water. Ear plugs may reduce discharge, and are often recommended in Australia.
What else should I know about grommets?
Sometimes the Grommets may get pushed out of the eardrum very early and if this happens they may need to be reinserted.
It is OK to fly in an aeroplane with grommets. The pain from the change in pressure in the aeroplane should not happen when the grommets are working.
We need to check your child’s hearing after grommets have been put in, to make sure their hearing is better.
Sometimes when a grommet comes out, a small hole is left behind. This usually heals up with time, and we rarely need to operate to close the hole. The grommet can leave some scarring in the eardrum. This does not affect the hearing.
Snoring and Obstructive Sleep Apnoea
Children often snore and this in itself is usually not a problem.
Sometimes however, the upper airway of a child can be significantly obstructed leading to "obstructive sleep apnoea", which is characterised by loud snoring punctuated by intermittent cessation of breathing.
This is most commonly due to severely enlarged adenoid and tonsil tissue.
If your child is a simple snorer then our advice would normally be to wait and watch as it is more than likely that he or she will grow out of the problem. Alternatively if you feel he or she is suffering from symptoms suggestive of “obstructive sleep apnoea” then do seek attention.
Following a clinical assessment we can usually advise as to whether surgery may be beneficial. Occasionally, further investigations with a sleep study may also be necessary.
What are the adenoids?
Adenoids are small glands in the throat at the back of the nose. They are there to prime the immune system in infants.
Why take them out?
Sometimes children have adenoids so big that they have a blocked nose, so that they have to breathe through their mouths. They snore at night. Some children even stop breathing for a few seconds while they are asleep.
The adenoids can also cause ear problems by stopping the tube which joins your nose to your ear from working properly. For some children, removing the adenoid at the same time as putting grommets in the ears seems to help stop the glue ear coming back. Removing the adenoids may also make colds that block the nose less of a problem for your child.
What are the alternatives to having the adenoids removed?
Your adenoids get smaller as you grow older, so you may find that nose and ear problems get better with time.
For some children, using a steroid nasal spray will help reduce congestion in the nose and adenoids, and may be helpful to try before deciding on surgery. Antibiotics are not helpful and only produce temporary relief from infected nasal discharge.
If we are taking adenoids out because of ear problems, we may put in grommets at the same time. If your child has sore throats or stops breathing at night, we may also take their tonsils out at the same time. We will tell you what these operations involve if we are going to do them.
Arrange for a week off school. Let us know if your child has a sore throat or a cold in the week before their operation - it may be safer to put it off for a few weeks.
Your child will be asleep for the operation. We will take out the adenoids through his or her mouth, and then stop the bleeding before he or she is woken up.
Adenoid surgery is done as a day case, so that the patient can go home on the same day as the operation. We will only let him or her go home when he or she is eating and drinking and feels well enough.
Most children need about a week off nursery or school. They should rest at home away from crowds and smoky places. Stay away from people with coughs and colds.
Adenoid surgery is very safe, but every operation has small risks. The most serious problem is bleeding, which may need a second operation to stop it. However, bleeding after adenoidectomy is very uncommon. It is very important to let us know well before the operation if anyone in the family has a bleeding problem.
During the operation, there is a very small chance that we may chip or knock out a tooth, especially if it is loose, capped or crowned. Please let us know if your child has any teeth like this.
What to expect after the operation
Some children feel sick after the operation. This settles quickly.
A small number of children find that their voice sounds different after the surgery. It may sound like they are talking through their nose a little. This usually settles by itself within a few weeks.
The child’s nose may seem blocked up after the surgery, but it will clear by itself in a week or so.
Your child may have sore ears. This is normal. It happens because your throat and ears have the same nerves. It does not mean your child has an ear infection.
Give painkillers as needed for the first few days. Do not use more than it says on the label. Do not give your child aspirin - it could make your child bleed.
What are tonsils and what do they do?
Tonsils are small glands in the throat, one on each side. They are there to prime the immune system in infants, the tonsils become less important and usually shrink. Your body can still fight germs without them.
Why take them out?
A tonsillectomy (an operation to remove the tonsils) is only recommended if they are doing more harm than good. The main indication is a history of frequent tonsillitis requiring repeated courses of antibiotics and time off school or work.
Another reason for removing the tonsils is if they are large and block the airway. This may manifest as significant snoring at night with brief pauses in the breathing pattern. A quinsy, which is an abscess that develops alongside the tonsil, as a result of tonsil infection is most unpleasant. People who have had a quinsy therefore often choose to have a tonsillectomy to prevent having another.
Before the operation
Arrange for two weeks off work or school. Let us know if you have a chest infection or tonsillitis before the admission date because it may be better to postpone the operation. It is very important to tell us if has you have any unusual bleeding or bruising problems, or if this type of problem might run in the family.
How is the operation done?
You will be asleep under general anaesthesia. The tonsils will be removed through the mouth, and then the bleeding is controlled and then you are woken up and sent to the recovery room.. This takes about 40 minutes.
How long will I be in hospital?
It is advisable to stay in hospital for one night, we will only let you go home when you are eating and drinking and feel well enough.
Tonsil surgery is very safe, but every operation has a small risk. The most serious problem is bleeding. This may rarely need a second operation to stop it. About two out of every 100 children who have their tonsils out will need to be taken back into hospital because of bleeding, and most will settle when treated with strong antibiotics. Only one of every 200 may need a second operation to stop the bleeding. Adults have a slightly higher risk of bleeding than children.
During the operation, there is a very small chance that we may chip or knock out a tooth, especially if it is loose, capped or crowned. Please let us know if you have any teeth like this.
What to expect after the operation
You may feel sick after the operation, and may need to be given medicine for this, but it usually settles quickly.
Your throat will be sore for approximately ten days. It is important to take painkillers regularly, half an hour before meals for at least the first week. Do not take aspirin because it may make you bleed. If you are giving painkillers to your child following tonsillectomy do not give more than it says on the label. Eat normal food - it will help your throat to heal. It will help the pain too. Drink plenty and stick to bland non spicy food. Chewing gum may also help the pain.
You may have sore ears. This is normal - it happens because your throat and ears have the same nerves. It does not mean that you have an ear infection.
Your throat will look white - this is normal while your throat heals. You may also see small threads in your throat – they are used to help stop the bleeding during the operation, and they will fall out by themselves.
Some people get a throat infection after surgery, usually if they have not been eating properly. If this happens you may notice a fever and a bad smell from your throat. Call your GP or the hospital for advice if this happens.
Adults and children will need 10 to 14 days off work or school. Make sure you rest at home away from crowds and smoky places. Keep away from people with coughs and colds. You may feel tired for the first few days.
Bleeding can be serious
If you notice any bleeding from your throat, you must see a doctor. Call your GP, call the ward, or go to your nearest hospital casualty department.
The advice and information contained herein is provided in good faith as a public service. However the accuracy of any statements made is not guaranteed and it is the responsibility of readers to make their own enquires as to the accuracy, currency and appropriateness of any information or advice provided. Liability for any act or omission occurring in reliance on this document or for any loss, damage or injury occurring as a consequence of such act or omission is expressly disclaimed.