Glue Ear

What is glue ear?

Glue ear is when sticky fluid builds up in the middle ear, the space behind your eardrum, instead of draining away as it normally would. It's also known as otitis media with effusion, and while it can affect your hearing, it doesn't usually cause pain.

What are the symptoms of glue ear?

The main symptom is temporary hearing loss, which can affect one or both ears. Other symptoms can include:

• a feeling of pressure or fullness in the ear
• mild earache
• ringing or buzzing in the ear (tinnitus)
• a popping sensation when swallowing
• problems with balance

Young children often can't describe these symptoms, so you might notice changes in behaviour instead, such as:

• talking loudly, or asking you to repeat things or turn up the volume
• becoming irritable, tired or frustrated
• struggling to concentrate, or wanting to play alone
• not responding when called
• rubbing or pulling at their ears

If glue ear lasts a long time, it can affect a child's speech development and progress at school. Adults with glue ear have the same symptoms as children.

What are the causes of glue ear and who is at risk?

Glue ear happens when the Eustachian tube, the narrow channel connecting your middle ear to the back of your nose and throat, becomes blocked. This stops air getting in and fluid draining out, so fluid builds up and thickens instead.

Things that can block the Eustachian tube or trigger glue ear include:

• a cold, flu or other upper respiratory infection
• an ear infection
• allergies, such as hay fever
• enlarged adenoids
• exposure to cigarette smoke
• changes in air pressure, such as flying or scuba diving

Glue ear can happen at any age, but it's most common in children aged 1–6, whose Eustachian tubes are narrower and more easily blocked. Children with a cleft palate or Down's syndrome are more likely to get it and to have it for longer, as they often have smaller Eustachian tubes that don't work as well. Attending childcare, bottle feeding, and having frequent respiratory infections also raise the risk. Adults can develop glue ear too, especially after a respiratory infection or with allergies.

Are there different types of glue ear?

Glue ear itself doesn't have separate named types, but how long it lasts affects what happens next. Most cases clear up within three months, though some children have longer-lasting or repeated episodes that need closer monitoring or treatment.

It's also worth telling glue ear apart from other conditions with similar symptoms:

• earwax build-up or an object stuck in the ear can also cause ear pain with a change in hearing
• a perforated eardrum, particularly after a loud noise or an accident, causes similar symptoms
• an ear infection with a high temperature is a separate condition, though it can sometimes lead to glue ear afterwards

How is glue ear diagnosed?

A doctor will ask about symptoms and recent infections, then look inside the ear with a lighted, magnifying instrument called an otoscope. This should not be painful.

If needed, you or your child may also have:

• a hearing test (audiometry), to check for and measure any hearing loss
• tympanometry, a quick, painless test that measures how well the eardrum moves, since fluid behind it reduces this movement

If glue ear has lasted more than three months, a referral to a specialist for further hearing tests is common.

How is glue ear treated?

Non-surgical treatments

Glue ear is not always treated straight away, because there's no medicine that reliably clears it and it often gets better on its own within three months. Your child may be monitored for up to a year in case things change.

• Autoinflation: blowing up a special balloon through one nostril, or swallowing while holding the nostrils closed, to help fluid drain. It needs to be done several times a day, so it isn't usually recommended under three years old
• Antibiotics: used if glue ear has caused an ear infection
• Steroid nasal spray: sometimes prescribed if hay fever or another allergy seems to be a factor
• Temporary hearing aids: including bone conduction devices worn on a headband, which convert sound into vibrations that bypass the middle ear altogether while the fluid clears

Surgical treatments

Surgery is usually only considered if glue ear hasn't improved after about three months, or if it's already affecting a child's learning, development or hearing.

• Grommets: tiny tubes placed in the eardrum during a short operation (myringotomy) under general anaesthetic, to drain fluid and let air back into the middle ear. Most people go home the same day, and the grommet usually falls out by itself within 6–12 months as the ear heals
• Adenoidectomy: removal of the adenoid glands at the back of the nose, often done at the same time as grommets, which can reduce how often glue ear comes back

A specialist will help you decide which option, if any, is right for your child.

When should I see a doctor?

See a GP if your child shows signs of a hearing problem, such as:

• speaking unusually loudly
• being difficult to understand
• regularly asking people to repeat themselves
• wanting the TV or music turned up loud
• struggling to hear people who are far away
• seeming tired, irritable or easily distracted because listening is harder work

It's also worth seeing a doctor if ear infections keep coming back, and to get hearing checked again once glue ear has cleared, to confirm it's back to normal.