Non surgical treatments for Glue Ear - alternatives to Grommets

What is Glue Ear?

Glue ear is a very common condition that affects 80% of children at some point during their childhood – 200,000 per year in the UK. Also known as secretory otitis media, otitis media with effusion or serous otitis media, more than 7 in 10 children have at least one episode of glue ear. Glue ear (also known as secretory otitis media, otitis media with effusion, or serious otitis media) is a very common condition among children. It usually occurs in young children, but can develop at any age and can affect one or both ears.

How does the ear work?

The ear is divided into 3 parts - the outer, middle, and inner ear. Sound waves come into the outer (external) ear and hit the eardrum causing the eardrum to vibrate. Behind the eardrum, in the middle ear, are three tiny bones (ossicles) - the malleus, incus, and stapes. The vibrations pass from the eardrum to these middle ear bones. The bones then transmit the vibrations to the cochlea in the inner ear. The cochlea converts the vibrations to sound signals which are sent down the ear nerve to the brain which we 'hear'.

The middle ear behind the eardrum is normally filled with air and is connected to the back of the nose by a thin channel, the Eustachian tube. This tube is normally closed. However, from time to time (usually when we swallow, chew or yawn), it opens to let air into the middle ear, and to drain any fluid out.

Psychological effects

Some children can also experience psychological, developmental and behavioural effects as a result of dulled hearing caused by glue ear. If glue ear goes un-noticed it may mean children do not learn as well as they cannot hear their teacher. They may also become frustrated, feel left out and become quiet and withdrawn as they cannot follow what is going on around them as easily.

Although some studies have also shown glue ear may also potentially cause problems with speech and language development, this is unlikely to occur in most children with glue ear. However, if you have any concern about your child's development, you should contact your GP.

Symptoms

The main symptom associated with glue ear is dulled hearing, which ranges from a slight muffle to moderately bad deafness in both ears to deafness in extreme cases. Below is a list of possible symptoms evident in glue ear children:

• Dulled hearing
• Problems with speech, language or social interaction
• Clumsiness or balance problems
• Appearing to have 'selective hearing' - for example, disobeying verbal instructions
• Turning up the volume on the television, or radio, or often saying 'what' or ‘uh’? a lot
• In the case of babies, being less responsive to sounds

Causes

A major cause of glue ear is thought to be due to the Eustachian tubes (which link the pharynx to the middle ear) not working correctly. If the Eustachian tube is narrow, blocked, or does not open properly, the balance of fluid and air in the middle ear may be altered. Air in the middle ear may gradually pass into the nearby cells if it is not replaced by air coming up the Eustachian tube, and a vacuum can then develop in the middle ear. Fluid may also seep into the middle ear from nearby cells.

Often glue ear children develop the condition after a cough, cold, or ear infection when extra mucus is produced. The mucus builds up in the middle ear and can struggle to drain down the Eustachian tube. However, many cases of glue ear do not begin with an obvious ear infection.

Diagnosis

If you suspect your child has glue ear, you need to visit your GP. Your GP will ask about your child's symptoms and medical history and then carry out a short ENT examination of your child focusing on the ear drums to ensure there is no infection in the ears.

Typically, after this initial examination, your GP will send you away and ask you to return in one to three months to see if there’s been any improvement. This is called ‘watchful waiting’. If there hasn’t been any improvement over this period, your child is more likely to be referred to an Ear, Nose and Throat (ENT) specialist.

The Audiologist will perform a tympanometry test, which is the best available way to confirm glue ear. This test bounces sound waves off the ear drum and measures its flexibility. If the condition is judged severe enough your child will go on a waiting list for one of the main forms of glue ear treatment: a grommet operation. This takes place under full anaesthetic.efore they are 4 years old, and boys are more commonly affected than girls.

Treatments for Glue Ear

Research has shown medicine is usually ineffective in treating glue ear. After glue ear children have been assessed for the severity of their condition, and any additional risks, it will often be a case of simply 'watching and waiting'. This is because almost half of all glue ear cases will cure themselves within three months.

Take action

However, there is also something parents can do during the ‘watchful waiting’ period in order to potentially prevent the need for surgery. You can speak to your GP about Otovent, a clinically effective, glue ear treatment designed to reduce the need for surgical intervention. It’s convenient, increases chances of a shorter recovery time from glue ear and is the only clinically effective non invasive glue ear treatment for use during the ‘watchful waiting’ period. It is also available over the counter.

Using Otovent

Otovent is a small balloon which the child blows up using their nose. Otovent equalises the pressure and relieves the symptoms in the middle ear. The act of blowing up the balloon helps to open up the Eustachian tube, making it easier for fluid to drain from the middle ear. Otovent is best used three times a day (morning, midday or after school, and evening), or at least twice a day (morning and evening) if that is not possible, until all the fluid has been drained away. You will often start to see results as early as a few days into using the Otovent.

Grommet operation

It is presently the most common effective treatment for glue ear. It is an effective method of treating glue ear, but best results are much more likely in children with more severe and prolonged histories. Surgery happens under general anaesthetic and usually takes about 15 minutes. During the procedure, a very small ventilation tube – a grommet - is inserted into your child's ear through a small incision (cut) in their eardrum. The grommet helps to drain away fluid in the middle ear and will also help to maintain the air pressure in the middle ear cavity. Your child should be allowed to go home the same day.
A grommet helps keep the eardrum open for several months. As the eardrum starts to heal, the grommet will slowly be pushed out of the eardrum and, in most cases, eventually falls out. This process happens naturally and should not be painful. The majority of grommets fall out between 6 to 15 months after they have been inserted and probably 30% of children may need further grommets inserted in order to fully treat the condition.
You should also talk to your surgeon about potential risks and careers that may be prohibited after grommets operation.

Other treatments

It's not recommended by the National Institute for Clinical Excelence (NICE) that your child takes antibiotics, antihistamines or decongestants for glue ear as they don't have any significant effect and have a number of harms or disadvantages. There is also the possibility that your child may have side-effects as a result of taking antibiotics

For more information visit www.gluear.co.uk