Treatment of glue ear with grommets

Need to know more about glue ear? We’ll explain what it is, how we treat it using grommets and what to expect when your child comes to Great Ormond Street Hospital (GOSH) to have them put in.

Glue ear (also called otitis media with effusion) means the middle ear contains a build-up of sticky fluid (or glue).

This can affect hearing because the middle ear can’t move freely, but the level of hearing loss is mild. Some children have recurrent glue ear, meaning it returns after treatment over a long period.

Because of the hearing problems that come with glue ear, this can cause speech and language development problems.

Glue ear tends to affect children under the age of seven, most commonly between the ages of two and five. Some children develop glue ear after a cold, so it can be more common during the winter months. It’s also more common in boys than girls, but we don’t know why yet.

The ear consists of three parts, the outer ear, the middle ear and the inner ear. Sound waves enter the ear canal and cause the eardrum to vibrate. The sound then passes through the middle ear through the three small bones of hearing (ossicles) on to the inner ear, which is filled with fluid.

The movement of the fluid in the cochlea stimulates the hair cells inside it to trigger a nerve impulse, which is carried to the brain by the auditory nerve. The brain then interprets these nerve impulses as sound.

We’re not exactly sure what causes glue ear, but doctors believe it’s connected to the Eustacian tube not functioning properly. The Eustacian tube usually keeps the air pressure on both sides of the eardrum equal. If the tube is blocked, this makes the air pressure inside the middle ear drop. Fluid drains from the surrounding tissue to fill up the middle ear. With time, this fluid becomes sticky and stops the eardrum and ossicles vibrating as they should.

We’ll start by looking inside your child’s ear to see if there’s any visible blockage of the ear canals and to check the appearance of the eardrum. We’ll then do some hearing tests to see if there’s any hearing loss and, if there is, whether it’s caused by glue ear. One of these tests (tympanometry) tests the mobility of the eardrum and can give an indication of whether glue is present.

Your child may already have been diagnosed by the time you visit GOSH, or we might diagnose it here.

If your child has a single case of glue ear, it may clear up by itself. However, if it continues and starts to affect their speech, language or schooling, the doctor may suggest treatment using grommets, which are inserted during an operation.

Grommets are tiny tubes inserted into the eardrum. They allow air to pass through the eardrum, keeping the air pressure on either side equal. The surgeon makes a tiny hole in the eardrum and inserts the grommet into the hole. It usually stays in place for six to 12 months and then falls out. This is normal and won’t affect your child.

Every operation carries some risk of infection and bleeding but the hole in the eardrum is tiny, so this risk is reduced. We’ll give your child a course of antibiotic eardrops to reduce the risk of infection further. Around one in every 100 children may develop a perforated eardrum. If this continues, we can repair it later. Every anaesthetic carries a risk, but it's very small. Modern anaesthetics are safe and your child’s anaesthetist will be an experienced doctor trained to deal with any complications.

For persistent glue ear, grommets are the treatment of choice. Medical treatment with decongestants or steroids isn’t particularly effective unless there are signs of infection or allergy. Antibiotics can help but only in the short term.

You'll have received information in your admission letter about how you can prepare your child for the operation. Doctors will then explain about the operation in more detail, discuss any worries you may have and ask you to give permission for the surgery by signing a consent form. Another doctor will also visit you to explain about the anaesthetic.

If your child has any medical problems, particularly allergies, please tell the doctors about these. Please also bring in any medicines your child is currently taking.

After the operation, your child will return to the ward to fully wake up from the anaesthetic. Once they feel comfortable and have had a drink, you’ll be able to take them home.

Your child’s ear may ooze or bleed for a day or two after the operation. This is normal and should stop within a few days. Your child may have mild earache, which is quite common.

• If your child’s ear is oozing or bleeding, clean the discharge from the outer ear, but don’t clean inside the ear

• Give your child pain relief medicines, such as paracetamol or ibuprofen, according to the instructions on the bottle or packet

• Your child should avoid water getting into their ear until the follow-up outpatient appointment, so they’ll need to take care during bathing and showering

• It can help to put some cotton wool with Vaseline® on it into your child’s outer ear. Don’t insert it in the ear canal itself, as it’d be difficult to remove

• If we prescribe eardrops, give the complete course according to the instructions on the bottle. Click here for some instructions on how to give your child ear drops or spray.

Your child will need to come back to the hospital for a check up appointment six weeks after the operation. We will send you details of this appointment.

Once we’ve diagnosed and treated glue ear, the outlook is good. Most children with speech and language delays catch up and go on to have a normal school life. A small proportion of children may need extra help from a speech and language therapist.