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Glue Ear & the Insertion of Grommets
What is Glue Ear?
Glue ear is a common condition that affects children.
Its medical name is ‘otitis media with effusion' or
'secretory otitis media' which describe the build-up of
a sticky glue-like fluid in the middle ear, behind the
eardrum.
What are the symptoms?
The symptoms of glue ear vary with age.
You may notice that your child gets repeated ear
infections and may seem slower to develop speech,
understanding and walking compared to other children.
When they start school, they may have difficulty
hearing the teacher and so may get behind in their
work.
Older children may be able to tell you if they cannot
hear very well. You may notice that they say 'pardon'
or 'what' a lot or that they turn the television up loud.
What causes Glue Ear and how common is it?
The ear is responsible for hearing and balance and is
made up of three parts - the Outer Ear (the parts of
the ear which you can see and the ear canal), the
Middle Ear (the ear drum and three tiny bones called
ossicles), and the Inner Ear.
What is Glue Ear?
Glue ear is a common condition that affects children.
Its medical name is ‘otitis media with effusion' or
'secretory otitis media' which describe the build-up of
a sticky glue-like fluid in the middle ear, behind the
eardrum.
What are the symptoms?
The symptoms of glue ear vary with age.
You may notice that your child gets repeated ear
infections and may seem slower to develop speech,
understanding and walking compared to other children.
When they start school, they may have difficulty
hearing the teacher and so may get behind in their
work.
Older children may be able to tell you if they cannot
hear very well. You may notice that they say 'pardon'
or 'what' a lot or that they turn the television up loud.
What causes Glue Ear and how common is it?
The ear is responsible for hearing and balance and is
made up of three parts - the Outer Ear (the parts of
the ear which you can see and the ear canal), the
Middle Ear (the ear drum and three tiny bones called
ossicles), and the Inner Ear.
| Diagram showing the anatomy of the healthy, 'normal' ear |
Sound waves travel through the ear canal to the
eardrum (a thin, taut membrane) and cause it to
vibrate.
The ossicles amplify these vibrations and carry them
to the Inner Ear. The Inner Ear translates the
vibrations into electric signals and sends them to the
brain where they are interpreted as sound.
To work properly, the Middle Ear must be at the
same pressure as the outside world. This is achieved
by the Eustachian Tube, a small passage that
connects the Middle Ear to the back of the throat
behind the nose.
By letting air reach the Middle Ear, the Eustachian
Tube keeps the air pressure in the Middle Ear equal
to the outside air pressure. The Eustachian Tube
also allows for drainage of mucus from the Middle
Ear into the throat.
We are not exactly sure what causes Glue Ear but
doctors believe it is related to the Eustachian Tube
not functioning properly.
If the tube is blocked, this causes the air pressure
inside the Middle Ear to drop and fluid drains from the
surrounding tissue to fill up the Middle Ear. With time,
this fluid becomes sticky and stops the ear drum and
ossicles vibrating as they should.
The blockage might be due to enlarged adenoids,
congestion from a cold (which is why it is more
common in winter), pet allergies, pollen, dust or
passive smoking.
It is estimated that one in four children are affected
with Glue Ear at some stage of their lives. However,
it mainly affects young children between the ages of
two and five years.
How is Glue Ear diagnosed?
The doctor will start by looking inside your child's ear
to see if there is any visible blockage of the ear
canals and to check the appearance of the ear drum.
This will be followed by some hearing tests to see
whether there is any hearing loss and if so, whether it
is caused by Glue Ear. One of these tests
(tympanometry) assesses the mobility of the ear
drum and can give an indication of whether glue is
present.
How is Glue Ear treated?
In most children, the condition clears up on its own.
However, if it persists and starts to affect their
speech, language or schooling, the doctor may
suggest treatments using grommets which are
inserted during an operation.
Grommets are tiny tubes that are inserted into the ear
drum and allow air to pass through the ear drum.
This keeps the air pressure equal on either side.
Are there any alternatives?
Left untreated, Glue Ear may lead to delayed speech,
long-term hearing loss and behavioral or educational
problems.
Medical treatment with decongestants or steroids has
not been shown to be particularly effective unless
there are signs of infection or allergy and for
persistent Glue Ear, grommets are the treatment of
choice.
What happens before the operation?
Before you come into hospital an ENT (Ear, Nose &
Throat) doctor in the Pre-Admission Clinic will
assess your child. The doctor will check your child is
well and still requires the planned operation. This
may involve another hearing test when you arrive if
your child hasn't had one recently.
You will then see the Pre-Admission Nurse who will
check your child's details and explain about coming
into hospital.
When you come into hospital, the doctor will ask you
to sign a consent form for your child's operation and
another doctor will also visit to explain about the
anaesthetic.
If your child has any medical problems, particularly
allergies, please tell the doctors about these. Also
bring any medicines your child is currently taking.
What does the operation involve and are there any
risks?
The surgeon makes a tiny hole in the ear drum and
inserts the grommet into the hole. The grommet
usually stays in place for six to twelve months and
then falls out. This is normal and will not affect your
child.
Every operation carries some risk of infection and
bleeding but as the hole in the ear drum is tiny, this
risk is very much reduced.
Around one in every 100 children may develop a
perforated ear drum. If this persists it can be
repaired at a later date.
What happens after the operation?
After the operation, your child will return to the ward
for at least 3 hours to fully wake up from the
anaesthetic. Once he or she feels comfortable, has
had something to drink and eat and has passed urine,
you will be able to take your child home.
Going Home
Give regular pain control medicine (e.g. paracetamol)
for the first 24 hours to prevent your child becoming
uncomfortable.
There may be some oozing or bleeding from the ear -
this is normal and should stop within a few days.
Do not clean the inside of the ear - only the outside.
Gently clean the ears using a twist of cotton wool or a
very soft cloth. Never use a cotton bud as you may
go too far into the ear and cause damage.
Care should be taken not to allow water to get into
your child's ear. Earplugs can be bought from the
chemist or cotton wool with a layer of Vaseline can
be used during washing, bathing and showering to
prevent water, soap and shampoo entering the ear
canal. With the earplugs or cotton wool/Vaseline
protection, your child can also continue to go
swimming provided they do not put their head under
water.
Flying is actually easier for children with grommets in
the ears. The grommet allows air in and out of the
ear and reduces the stress on the ear drum that is
caused by changes in air pressure in the aircraft.
You will be seen in the ENT Outpatients
Department at some point after the operation. Your
appointment details will be sent to you in the post.
If there are any problems before then, please see
your GP or contact the Children's Surgical Ward.
What is the outlook for children with Glue Ear?
Once Glue Ear has been diagnosed and treated, the
outlook is very good.
Most children with speech and language delays
caused by Glue Ear catch up and go on to have a
normal school life. A small proportion of children may
need extra help from a Speech and Language
Therapist.
Grommets usually stay in place for six to twelve
months and then fall out. They move outwards with
earwax until they fall out of the ear canal, often
unnoticed. Occasionally they stay in place and may
require another operation to remove them.
Over half of children who have grommets do not need
further surgical treatment as they get older.
However, some children will need grommets inserted
a number of times until their Glue Ear improves.
Although the ear drum is tough, repeated grommet
insertions may eventually scar it which can sometimes
cause a hearing loss.
eardrum (a thin, taut membrane) and cause it to
vibrate.
The ossicles amplify these vibrations and carry them
to the Inner Ear. The Inner Ear translates the
vibrations into electric signals and sends them to the
brain where they are interpreted as sound.
To work properly, the Middle Ear must be at the
same pressure as the outside world. This is achieved
by the Eustachian Tube, a small passage that
connects the Middle Ear to the back of the throat
behind the nose.
By letting air reach the Middle Ear, the Eustachian
Tube keeps the air pressure in the Middle Ear equal
to the outside air pressure. The Eustachian Tube
also allows for drainage of mucus from the Middle
Ear into the throat.
We are not exactly sure what causes Glue Ear but
doctors believe it is related to the Eustachian Tube
not functioning properly.
If the tube is blocked, this causes the air pressure
inside the Middle Ear to drop and fluid drains from the
surrounding tissue to fill up the Middle Ear. With time,
this fluid becomes sticky and stops the ear drum and
ossicles vibrating as they should.
The blockage might be due to enlarged adenoids,
congestion from a cold (which is why it is more
common in winter), pet allergies, pollen, dust or
passive smoking.
It is estimated that one in four children are affected
with Glue Ear at some stage of their lives. However,
it mainly affects young children between the ages of
two and five years.
How is Glue Ear diagnosed?
The doctor will start by looking inside your child's ear
to see if there is any visible blockage of the ear
canals and to check the appearance of the ear drum.
This will be followed by some hearing tests to see
whether there is any hearing loss and if so, whether it
is caused by Glue Ear. One of these tests
(tympanometry) assesses the mobility of the ear
drum and can give an indication of whether glue is
present.
How is Glue Ear treated?
In most children, the condition clears up on its own.
However, if it persists and starts to affect their
speech, language or schooling, the doctor may
suggest treatments using grommets which are
inserted during an operation.
Grommets are tiny tubes that are inserted into the ear
drum and allow air to pass through the ear drum.
This keeps the air pressure equal on either side.
Are there any alternatives?
Left untreated, Glue Ear may lead to delayed speech,
long-term hearing loss and behavioral or educational
problems.
Medical treatment with decongestants or steroids has
not been shown to be particularly effective unless
there are signs of infection or allergy and for
persistent Glue Ear, grommets are the treatment of
choice.
What happens before the operation?
Before you come into hospital an ENT (Ear, Nose &
Throat) doctor in the Pre-Admission Clinic will
assess your child. The doctor will check your child is
well and still requires the planned operation. This
may involve another hearing test when you arrive if
your child hasn't had one recently.
You will then see the Pre-Admission Nurse who will
check your child's details and explain about coming
into hospital.
When you come into hospital, the doctor will ask you
to sign a consent form for your child's operation and
another doctor will also visit to explain about the
anaesthetic.
If your child has any medical problems, particularly
allergies, please tell the doctors about these. Also
bring any medicines your child is currently taking.
What does the operation involve and are there any
risks?
The surgeon makes a tiny hole in the ear drum and
inserts the grommet into the hole. The grommet
usually stays in place for six to twelve months and
then falls out. This is normal and will not affect your
child.
Every operation carries some risk of infection and
bleeding but as the hole in the ear drum is tiny, this
risk is very much reduced.
Around one in every 100 children may develop a
perforated ear drum. If this persists it can be
repaired at a later date.
What happens after the operation?
After the operation, your child will return to the ward
for at least 3 hours to fully wake up from the
anaesthetic. Once he or she feels comfortable, has
had something to drink and eat and has passed urine,
you will be able to take your child home.
Going Home
Give regular pain control medicine (e.g. paracetamol)
for the first 24 hours to prevent your child becoming
uncomfortable.
There may be some oozing or bleeding from the ear -
this is normal and should stop within a few days.
Do not clean the inside of the ear - only the outside.
Gently clean the ears using a twist of cotton wool or a
very soft cloth. Never use a cotton bud as you may
go too far into the ear and cause damage.
Care should be taken not to allow water to get into
your child's ear. Earplugs can be bought from the
chemist or cotton wool with a layer of Vaseline can
be used during washing, bathing and showering to
prevent water, soap and shampoo entering the ear
canal. With the earplugs or cotton wool/Vaseline
protection, your child can also continue to go
swimming provided they do not put their head under
water.
Flying is actually easier for children with grommets in
the ears. The grommet allows air in and out of the
ear and reduces the stress on the ear drum that is
caused by changes in air pressure in the aircraft.
You will be seen in the ENT Outpatients
Department at some point after the operation. Your
appointment details will be sent to you in the post.
If there are any problems before then, please see
your GP or contact the Children's Surgical Ward.
What is the outlook for children with Glue Ear?
Once Glue Ear has been diagnosed and treated, the
outlook is very good.
Most children with speech and language delays
caused by Glue Ear catch up and go on to have a
normal school life. A small proportion of children may
need extra help from a Speech and Language
Therapist.
Grommets usually stay in place for six to twelve
months and then fall out. They move outwards with
earwax until they fall out of the ear canal, often
unnoticed. Occasionally they stay in place and may
require another operation to remove them.
Over half of children who have grommets do not need
further surgical treatment as they get older.
However, some children will need grommets inserted
a number of times until their Glue Ear improves.
Although the ear drum is tough, repeated grommet
insertions may eventually scar it which can sometimes
cause a hearing loss.