GLUE EAR

Glue ear is the most common ear condition seen in children. It is synonymous with terms like secretory otitis media, serous otitis media or non-suppurative otitis media. In my experience, this is one condition which needs a detailed counseling for the parents to help them understand the seriousness of the condition.

WHAT IS GLUE EAR?

Glue ear is a condition in which serous or mucoid fluid accumulates in the middle ear space. A normal middle ear space is usually filled with air whereas in glue ear this space gets filled by glue like fluid. With fluid blocking the middle ear, it becomes harder for sound to pass through to the inner ear, making feeble sounds difficult to hear. 

HOW IS THE GLUE ACCUMULATING IN THE MIDDLE EAR?

The middle ear is an air filled cavity lined by a mucous membrane and is occupied by three middle ear bones. The middle ear is also connected to the pharynx by the Eustachian tube which is normally collapsed, but can equalize pressure between the middle ear and the outside air.

In addition to equalizing pressure, the Eustachian tube has a lining which has hair like structures (Ciliary Lining) that beats in the direction of the middle ear cavity towards the pharynx. This arrangement clears both mucus and pathogens from the middle ear cavity. Interference with the ciliary function can result in accumulation of mucous or glue in the middle ear. Similarly obstruction or interference with the functioning of Eustachian tube can result in Glue ear.

SYMPTOMS OF GLUE EAR

Its most commonly seen in children below the age of 10 years. More number of kids between the age group of 3 to 6 years have visited my clinic with glue ear in comparison to other age groups. Children who have just entered schooling or daycare facilities have shown to be more prone to Upper Respiratory Infections leading to Glue ear.

Glue ear is more frequently identified as an incidental finding during an ENT evaluation for Upper Respiratory Infection or Snoring. The most common presentation in my practice is parents complaining of strained hearing /child watching TV at higher volume / less responsive to usual sounds or responding frequently with "Pardon? ". The degree of hearing loss can vary in different children is usually temporary or reversible at early stages.

Ear pain or ache is another symptom that occasionally children complaint about during an acute episode or active infection of the ear.

METHODS FOR PREVENTION

• Feeding infants in upright position

• Avoiding allergy triggers

• Treating ear infections promptly

• Encourage children to blow their nose rather than sniffing

• Hearing evaluation prior to school joining

TREATMENT FOR GLUE EAR

• Resolution of glue ear can take few weeks to months with supportive care and medical management. In my experience there have been cases which took close to two months for complete resolution.

• It is also important to identify the cause of Eustachian tube dysfunction and treating the cause simultaneously. Most common conditions include adenoid hypertrophy, severe allergy or recurrent upper respiratory infection.

• If not resolving with conservative management after 3 months, will require Grommet insertion. Grommets are tiny ventilation tubes that are inserted in the ear drum to allow air into the middle ear and prevents fluid build up in the middle ear.

• If adenoid hypertrophy obstructing Eustachian Tube is persisting despite of medical management, surgical removal of adenoids may be required along with grommet insertion.

GROMMET INSERTED IN THE TYMPANIC MEMBRANE

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References

1. Br Med J (Clin Res Ed) 1983;287:1586

2. British Medical Journal 1990;300:1551

3. Special Senses - Vision and Hearing, Bruce M. Carlson MD, PhD