Fluid in Ear - "Glue Ear"

The runny, snotty fluid that gets into the middle ear when a child has a cold can stay around. Even after a treatment course of antibiotics for acute otitis media the fluid in the middle ear may persist for weeks. This fluid usually goes eventually but in some children the fluid in ear persists beyond 3 months and when this occurs, we call it "otitis media with effusion" (OME) or more commonly, “glue ear”.

However, even without treatment, most “glue ear” fluid will eventually clear after 3-6 months without any treatment. So in most cases, fluid in ear will eventually disappear by itself.

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What causes build up of fluid in ear?

The fluid usually drains down the Eustachian tubes from the middle ear to the back of the nose and throat. When the tubes are blocked, glue-like fluid builds up in the middle ear, and this fluid in ear interferes with normal vibration of the eardrum.

Things that can block the Eustachian tube include:

• large adenoids
• a blocked nose
• a cold
• allergies

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Does “glue ear” cause deafness?

Having "glue ear" (fluid in ear) interferes with the normal conduction of sound through the middle ear and so children with “glue ear” have fluctuating hearing loss. You may notice that they sit close to the television or they don't hear you call them. The fluid in ear is dampening the sound for them.

Parents are often concerned that this will affect their child’s speech and language development. Studies comparing children less than 3 years of age with “glue ear” (fluid in ear) who either had tympanostomy tubes inserted or who just waited, found no difference in those children at 6 years of age with respect to IQ or other tests of language. So there is no need to rush into surgery to have ear tubes (grommets) inserted if your toddler has “glue ear” (fluid in ear) on the basis of their speech development.

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How do I know if my child has glue ear (fluid in ear)?

The main symptom will be loss of hearing and your child may have recurrent ear infections, so complain of ear pain etc. read more.

If you are worried that your child is not hearing, see your doctor who can check to see if there is any sign of fluid behind the eardrum. Your doctor or nurse may also do a test called an impedance tympanogram which will show up poor sound conduction as a result of fluid in the ear ("glue ear").

Breathing through the mouth and snoring may be signs of large adenoids, so see your doctor if your child does either of these all the time.

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What can I do to help if my child has fluid in the ear ("glue ear")?

Remember to speak slowly and clearly to your child. If she is at pre-school, let the teacher know so she can sit near the front of the class.

Fluid in ears of pre-schoolers is not uncommon and teachers are usually aware of the importance of ensuring children hear well.

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What treatments are available for “glue ear” (fluid in ear)?

In 85% of cases, the “glue ear” fluid will have disappeared without any treatment by 6 months, (it will have gone in 60% of children within 3 months). However, that still means 15% of children will still have some fluid in the ear after 6 months.

Tympanostomy tubes (called ear tubes or grommets depending on where you live) will clear the middle ear fluid. Ear tubes or grommets are usually required if:

• glue ear lasts longer than 3 - 6 months
• if there are recurring infections such as more than 3 in a six-month period
• if there is evidence of damage to the eardrum
• if there is more than just mild hearing loss

A recent review of the literature regarding decongestants and/or anti-histamines for the treatment of fluid in the ear, has shown that they are of no benefit and can cause unwanted side effects, so they should not be used.

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What are ear tubes (grommets)?

Tympanostomy tubes (ear tubes or grommets) are small plastic ventilating tubes about the size of a match head thatare placed in the eardrum during a brief surgical procedure conducted undergeneral anesthetic. The aim is to provide a way for the sticky fluid in ear to be removed.

During surgery for tympanostomy tubes, when the sticky glue residue (fluid in ear) is removed, this commonlyresults in an instant improvement in the child’s hearing.

Also because the insertion of tympanostomy tubes allows air flow to the middle ear, this can prevent ear infections: studies have shown that tympanostomy tubes prevent recurrent ear infections for the first six months after they are inserted, but don’t have a significant effect for the following 18 months.

So tympanostomy tubes help fluid in ear and also give your child some relief from ear infections for a few months.

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What is the risk of ear tube (grommet) insertion?

There is always a risk when a child has an anesthetic, and the risk of the anesthetic must be weighed up against the potential benefit of the surgery. However, when performed by an experienced surgeon, insertion of tympanostomy tubes is relatively safe.

There is a small risk that the surgery will lead to long term changes in the eardrum because of scarring where the tubes are inserted. Whether this is of any significance in the long-term is not clear.

In the end, the decision to have ear tubes inserted or not, will depend on whether your child’s symptoms are causing enough problems to outweigh the small risk of an anesthetic. Tympanostomy tubes can improve a child’s quality of life in the short term.

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How long do ear tubes (grommets) stay in the eardrum?

It depends on their size how long they remain before falling out. If medium term ventilation tympanostomy tubes are inserted in youngchildren they stay in for six to twelve months. The tube usually blocksfrom the inside when it is at the end of its usefulness and is pushed out bythe eardrum as part of the natural healing process in the ear. More often than not, they are found on a pillow. Some children may require a second set of tubes if they get recurrent problems, but for most one set is enough.

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Can my child swim with ear tubes (grommets)?

While tympanostomy tubes are in place, children must only swim on the surface of the water and should wear earplugs and a swimming cap, to prevent water from entering the middle ear via the tube. Water in the middle ear causes pain and can lead to infection.

An easy way to plug the ears is to use Blu-Tack - use a large flat piece to cover most of the ear.

After a few months, if your child doesn't complain of pain in the ear, she can swim without plugs and a cap but shouldn't dive under the water.

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Can my child fly with ear tubes (grommets)?

Yes. Your child should have less problems flying with tubes in place than if she didn't. The ear tube (grommet) allows the ear pressure to equalize easier than when there is no tube in place.

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