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Hearing Loss due to Glue Ear

This article has been supplied by Naomi Austin BSc MSc CS. Naomi is a Clinical Scientist working at The Royal Berkshire Hospital.

Introduction
Glue ear is a condition that affects many young children, most commonly before 12 months of age. It can affect one or both ears at a time. Glue ear is usually a temporary condition that most children grow out of. In about 50% of cases, glue ear will spontaneously resolve over 3 months so no intervention is needed. However, it can be treated successfully if it persists.

What is glue ear?
When a sound enters the ear, the eardrum moves back and forth to send the sound further up the hearing pathway. The space behind the eardrum is filled with air to allow the eardrum to move freely but sometimes fluid collects in this space. This happens when the tube which connects the middle part of the ear to the back of the throat (Eustachian Tube), which keeps this space filled with air, does not work very well. This may happen after a cold or ear infection. The fluid makes it more difficult for the eardrum to move, which may muffle some sounds.

What are the symptoms of glue ear?
When a child has glue ear their hearing may change from day to day or be poor all of the time. In some cases, children with glue ear hear at near normal levels. The fluid itself is not harmful, however, it can sometimes cause an ear infection. In such cases, treatment with antibiotics may be advised.

There are a variety of symptoms of glue ear, however not every child will show all of them. They include:

• difficulty hearing e.g. asking for the television to be turned up, asking for things to be repeated
• speech delay e.g. unclear speech, mispronouncing words, talking too loudly or talking less
• changes in behaviour e.g. difficulty concentrating, being irritable or withdrawn

Diagnosis
Following a referral by your GP or Health Visitor, an appointment will be made for you to attend an Audiology or Ear Nose and Throat (ENT) clinic so that your childs' hearing can be assessed. We will also carry out a quick test to see whether there is any fluid behind your childs' eardrum. This involves resting a small probe in the ear to see how well the eardrum is moving. It is not painful. If fluid is found and following discussions with you, the most appropriate way of managing the fluid will be decided upon.

Management Options
The following options may be discussed with you by the Audiology and ENT doctor:

'Watchful Waiting'
For most children, a period of 'watchful waiting' is advised, once the glue ear has been diagnosed. This means that your child is called back in a few months to re-check hearing and to see whether the fluid has cleared or not. The time of year is likely to affect how quickly this happens. Glue ear is more likely to resolve during the summer months when your child is less likely to catch colds. The ENT doctor and Audiologists involved will take this into account and other factors when deciding how long to wait before other treatment options are considered. These include how well your child is hearing at home or at school, whether your child is prone to frequent ear infections and whether his/her speech is developing properly.

Grommets
Grommets are usually very successful in the short term at treating glue ear or frequent ear infections. A grommet is a miniature tube which is inserted into the eardrum after the fluid behind it has been drained away. The grommet helps to keep the space behind the eardrum free from fluid and well ventilated. The grommet usually stays in place for an average of 9 months and is eventually pushed out as the eardrum naturally heals up. The ENT doctor will discuss with you whether grommets are suitable for your child. The operation is very common and safe. A light, general anaesthetic and usually a day in hospital will be required. A few weeks after the operation, an appointment will be made for you to have your child's hearing checked again and for the ENT doctor to check on your child's progress. They may also suggest removing your child's adenoids at the same time as putting in the grommets. This may help stop the glue ear returning and can help prevent frequent colds or other infections.

Hearing Aid(s)
Hearing aids are a temporary but effective way to help your child hear those sounds s/he is missing at home or in the classroom, because of glue ear. A hearing aid consists of an earmould, which sits inside the outer part of the ear, and the hearing aid itself, which connects to the earmould and sits over the back of the ear. When a hearing aid is fitted, the Audiologist will spend time with you and your child to help you understand how to use and look after it. Regular appointments are arranged to monitor your child's progress with the hearing aid and additional professional support is provided to ensure your child gets the most from their hearing aid both at home and at school.

Referral to other professionals
If you and/or any professionals have concerns regarding your child's speech and language development, a referral to a Speech and Language Therapist may be discussed with you. Similarly, a referral to a Paediatrician can be arranged should there be concerns regarding your child's general development.

What can I do to help?
There are lots of ways that you can help your child to make the most of their hearing when it is poor. Here are some of them:

At home

• attract your child's attention before speaking to them e.g. call their name
• make sure they can see your face when you are speaking to them
• speak clearly and don't shout
• keep your instructions short and simple
• reduce background noise ie. Television, washing machines

NOTE:
The health section of Parenting.co.uk is not to be used as a substitute for your GP; if your child is ill then seek the advice of a qualified doctor or other health professional without delay.

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