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Glue Ear

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Ismail Munir

Overview

The glue ear is an inflammation of the middle ear that is frequently accompanied by a sticky discharge. In medical terms, this condition is referred to as &lsquo;otitis media with effusion or OME.&rsquo; The episodes are generally brief but can reoccur and cause hearing loss.

Glue ear is a very significant issue in young kids. 8 out of 10 children develop it before they turn 10<a href="#accordion">[7]</a>. Although glue ear is less prevalent among older kids, it can still occur. 
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There is a greater prevalence among 2-year-olds and it decreases after age 5. OME is more common in the winter, which correlates with rising patient rates of upper respiratory tract infections<a href="#accordion">[1]</a>. 
&nbsp;

It is also linked to hearing loss<a href="#accordion">[2]</a>. With time, glue ear can potentially cause a middle ear infection. It can make it very challenging for the child to hear anything at all. While it typically resolves on its own in about three months, in certain situations, surgery is required to avoid severe complications. 
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Signs and Symptoms

Short-term hearing loss is the most typical symptom of glue ear. It is possible for both ears to be affected at the same moment. 
&nbsp;

<h5>Signs And Symptoms In Children</h5>

A kid who has a glue ear can exhibit the following symptoms:

<ul>
	<li>They talk a little louder than usual</li>
	<li>They need help hearing others speak at standard volume levels</li>
	<li>They have trouble hearing noises when standing at a distance </li>
	<li>They request individuals to repeat themselves </li>
	<li>They ask to increase the volume of electronic devices </li>
	<li>They keep complaining of beeping or buzzing in their ears 
	&nbsp;</li>
</ul>

It can feel like they&rsquo;re wearing noise-canceling earplugs that mute the noises around them. Persistent hearing loss in the kid can lead to speech impairment. For example, they have difficulty pronouncing words. 
&nbsp;

<h5>Signs And Symptoms In Toddlers</h5>

A toddler can exhibit the following symptoms of glue ear:

<ul>
	<li>Speaks louder than they normally do</li>
	<li>Are hard to comprehend</li>
	<li>Requests for the TV or sound to be loud</li>
	<li>Need help hearing individuals who are far away</li>
	<li>Becomes quickly disturbed when individuals are communicating</li>
	<li>Appear exhausted and grumpy because it is more difficult to listen 
	&nbsp;</li>
</ul>

<h5>Signs And Symptoms In Adults</h5>

Adults with glue ear will experience similar symptoms as kids. The main symptom is, of course, the loss of hearing. However, it&rsquo;s also possible that adults suffering from glue ear feel pain or pressure deep inside their ears. Overall, they&rsquo;ll also appear tired and exhibit significant discomfort. 
&nbsp;

Causes

Glue ear occurs when a relatively thick fluid accumulates inside the middle ear. Like other types of ear infections, the glue ear is more prevalent among children. However, OME can affect both children and adults, and the etiology of these groups is different as well. 
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A child&rsquo;s middle ears must be clear and full of air for them to typically hear. The Eustachian tubes, which link the child&#39;s middle ears to their throat, carry air. This tube is broader and horizontally situated in young children, particularly so it does not function as well. 
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As the children mature into an adult, the tube lengthens and angles caudally. Resultantly, OME is more widespread among children. The placement of the head at this age can also affect the progression of OME. 
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When the kid&#39;s Eustachian tubes become blocked, the air cannot enter the middle ears. When this happens, the cells lining their middle ears produce a thick, gooey fluid. That&#39;s where the name of the condition &quot;glue ear&quot; originated. 
&nbsp;

Blockages can occur for various reasons:

<ul>
	<li>Colds and <a href="https://merisehat.pk/disease/influenza-116">influenza</a></li>
	<li><a href="https://merisehat.pk/disease/allergies">Allergies</a></li>
	<li>Enlarged adenoids</li>
	<li>Irritants, such as secondhand cigarette smoke</li>
	<li>Hereditary disorders, like Down syndrome</li>
	<li>Cleft palate</li>
	<li><a href="https://merisehat.pk/disease/gerd-56">GERD </a></li>
	<li>Drinking while lying down, for example, when breastfeeding.</li>
	<li>Increased air pressure, such as when flying or scuba diving 
	&nbsp;</li>
</ul>

When fluid affects the child&#39;s middle ears, it is more difficult for their eardrums to oscillate and transmit an audio signal to their inner ears. This can make hearing more challenging for the baby. 
&nbsp;

Diagnosis

A healthcare provider considers glue ear in kids when they present with a hearing problem, poor learning (especially language acquisition), academic problems, and behavioral or sleep disorders. 
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A pediatrician will examine the child&rsquo;s ears to identify the glue ear. They&#39;ll look inside the baby&#39;s ear with a high-magnification scope and a light attached to it. This device can assist them in determining the exact place of buildup 
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They&rsquo;ll ask parents to keep an eye on their situation to see whether it improves on its own. In case the glue ear returns or persists longer than three months, the child needs to be referred to a hearing specialist. 
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<h5>Differential Diagnosis</h5>

OME must be differentiated from acute otitis media, which is an ear infection due to impaired function of the Eustachian tube, and nasopharyngeal carcinoma. 
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<h5>Testing</h5>

If the child&rsquo;s healthcare provider suspects glue ear, they&rsquo;ll send them to an audiologist or an ear, nose, and throat specialist for further testing. 
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<h5>Tympanometry</h5>

This test evaluates how well the child&rsquo;s eardrums move. The doctor places a sound source and a special device with a microphone into the child&rsquo;s ear canal. When sound waves bounce off the child&rsquo;s eardrum, the device compares the pressures in the ear canal. In case the child has fluid buildup in their middle ears, their eardrums won&rsquo;t move correctly. 
&nbsp;

<h5>Auditory Brainstem Responses (ABR)</h5>

Auditory brainstem responses (ABR) is a specialized test used to measure how well a sound is conducted through the ear and passed onto the midbrain, particularly in newborns and young children. The sound volume varies throughout the test so that the doctor can evaluate the child&rsquo;s hearing threshold for each ear. It is only done while the baby is asleep. 
&nbsp;

<h5>Classic Audiology Exam</h5>

A classic audiology exam is more commonly preferred for older children and adults. This test mainly comprises playing different tones of varying intensities to the child&#39;s left and right ears. When a sound is heard in the right ear, patients are asked to raise their right hand or vice versa. The findings reveal the individual&rsquo;s frequency range and normal hearing levels. 
&nbsp;

During an audiology exam, the range of frequencies a person can interpret schemes on an audio graph. The WHO classification of the severity of hearing impairment is outlined below<a href="#accordian">[5]</a>:

<ol>
	<li>Slight impairment: 26-40 dB</li>
	<li>Moderate impairment: 41-60 dB</li>
	<li>Severe impairment: 61-80 dB</li>
	<li>Profound impairment, including deafness: 81 dB or greater. 
	&nbsp;</li>
</ol>

Treatment

It is not always possible to treat glue ear. Typically, the healthcare practitioner will wait a few months to see whether the fluid resolves on its own. That&#39;s because there is no effective therapy for glue ear, and it usually goes away after three months. 
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Many factors, such as the following, influence clinician decisions regarding the appropriate interventional treatment of OME for a particular patient:

<ul>
	<li>Comorbidities of the patient</li>
	<li>The degree of hearing loss</li>
	<li>OME presence unilaterally or bilaterally</li>
	<li>Duration of effusion</li>
	<li>Patient&#39;s age 
	&nbsp;</li>
</ul>

Furthermore, a doctor will consider all physical and social factors to devise a patient-centered treatment plan to improve the patient&rsquo;s outcomes. 
&nbsp;

NOTE: The hearing must be assessed prior to and after treatment (using an age-appropriate audiometry method) to avoid missing another root cause of deafness (e.g., perception deafness). 
&nbsp;

<h5>Antibiotics</h5>

If the baby is in pain and has an accumulation of fluid in their ears, they probably have an ear infection. Antibiotics are used to treat glue ear that progresses to a middle ear infection.

However, complications due to long courses of antibiotics (e.g., antibiotic resistance) and the fact that they only provide relief for a short time only mean they are not considered a common treatment for glue ear. 
&nbsp;

<h5>Autoinflation</h5>

While waiting for symptoms to improve, doctors sometimes suggest autoinflation to help drain the fluid accumulated in the ear.

It is accomplished by either:

<ul>
	<li>Blowing up a special balloon using one nostril at a time</li>
	<li>Swallowing while holding the nostrils closed 
	&nbsp;</li>
</ul>

However, the only catch is this treatment is not recommended for children younger than the age of three because it needs to be done multiple times a day. 
&nbsp;

<h5>Grommets</h5>

During surgical intervention, a grommet is a small tube that&rsquo;s placed in the child&rsquo;s ear. It drains the fluid while keeping the eardrum open.

Grommet is only temporary; it falls out naturally once the child&rsquo;s ear improves within 6-12 months. 
&nbsp;

<h5>Myringotomy</h5>

This is a surgical procedure during which the professional makes a minor cut in the child&rsquo;s eardrum to allow fluid to drain from the middle ear.

Additionally, a small, hollow ear tube is inserted into the cut. The tube aids in balancing the pressure in their eardrum with the pressure in their middle ear. It also allows drainage from the child&rsquo;s middle ear to the outer ear. The tube generally falls out on its own after about one year. 
&nbsp;

<h5>Adenoidectomy</h5>

Adenoidectomy is performed in cases of OME that involve enlarged adenoids and is frequently performed at the same time as a myringotomy. During the procedure, the doctor basically removes the child&rsquo;s enlarged adenoids.

This is because when the adenoids become inflamed or irritated, it can also cause inflammation or irritation in the Eustachian tubes, resulting in fluid accumulation and possible ear infections.

NOTE: During and after surgery, the patient is required to wear grommets. 
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<h5>Hearing Aids</h5>

Hearing aids are devices that enable a person to hear clearly if they suffer from temporary hearing loss or are waiting for their glue ear to resolve. Since they are a non-invasive treatment option for OME, they are also used when a myringotomy is not feasible. 
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<h5>Speech Therapy</h5>

If lack of hearing has affected the child&rsquo;s developmental milestones, it&rsquo;s best to seek speech therapy for them as well. 
&nbsp;

<h5>Natural Treatment</h5>

It&rsquo;s possible to treat the child&rsquo;s glue ear at home. The DIY techniques include: 
&nbsp;

<ul>
	<li>Valsalva Maneuver</li>
</ul>

The Valsalva maneuver is a breathing procedure that the child can use to unblock their ears. The child will close their mouth and pinch their nostrils. They will then forcibly blow air out of their nostrils, following which they should feel their ears &ldquo;pop.&rdquo;

<ul>
	<li>Nasal balloon</li>
</ul>

The child sticks a nasal balloon nozzle in one of their nostrils. Next, they block the other nostril with another finger and try to inflate the balloon using just one nostril. This exercise is to drain the Eustachian tube by forcing air from the back of the throat to the middle ear.

NOTE: Always consult a medical professional about the best course of action. 
&nbsp;
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Ear infections and, in cases where hearing loss is more severe, a delay in speech and language development are potential side effects of glue ear. Older children may struggle with reading and spelling as well as have trouble communicating and concentrating at school especially due to glue ear.

The eardrum (tympanic membrane) may be damaged by glue ear if it is ignored for a long time. 
&nbsp;

These include:

<ul>
	<li>Tobacco smoke exposure</li>
	<li>Being bottle-fed</li>
	<li>Age, particularly children under 2</li>
	<li>Seasonal allergies</li>
	<li>Higher risk of germ exposure in a social setting, such as at a daycare</li>
	<li>Poor air quality 
	&nbsp;</li>
</ul>

It could be challenging to prevent glue ear, especially in young children. Staying healthy and supporting the development of the child&rsquo;s immune system is one strategy.

Additionally, identify and treat allergies and reduce exposure to smoke and other irritants. This includes avoiding smoking in presence of children and regular cleaning and disinfecting of surfaces and toys to avoid exposure to pollen, dust mites, fur if they&rsquo;re allergic to it.

Also, while feeding, make sure the baby is in a seated position rather than laying them flat. 
&nbsp;

In this study, researchers examine the validity of the Rinne and Weber tests in different frequencies of tuning forks to predict the conductive hearing loss secondary to OME as diagnosed by more advanced audiometric tests.

Each patient was evaluated by tuning fork tests (256, 512, 1024, 2048 Hz), tympanometry, audiometry, and tympanocentesis.

It was concluded that the 256 Hz Rinne test can predict the presence of a conductive hearing loss in patients diagnosed with OME<a href="#accordion">[6]</a>. 
&nbsp;

Key Points

<ul>
	<li>The glue ear is an inflammation of the middle ear that is frequently accompanied by a sticky discharge. In medical terms, this condition is referred to as &lsquo;otitis media with effusion or OME.&rsquo;</li>
	<li>Short-term hearing loss is the most typical symptom of glue ear.</li>
	<li>The primary clinical advice for treating kids with confirmed or suspected glue ear is careful monitoring (watchful waiting) for three months because glue ear is typically anticipated to resolve naturally. 
	&nbsp;</li>
</ul>
<quillbot-extension-portal></quillbot-extension-portal>

[1] Searight FT, Singh R, Peterson DC. Otitis media with effusion. In: StatPearls [Internet]. StatPearls Publishing; 2022.

[2] Hall AJ, Maw R, Midgley E, Golding J, Steer C. Glue ear, hearing loss and IQ: an association moderated by the child’s home environment. PLoS One. 2014;9(2):e87021

[3] Cai T, McPherson B, Li C, Yang F. Pure tone hearing profiles in children with otitis media with effusion. Disabil Rehabil. 2018;40(10):1166–75.

[4] Warren MP. The auditory brainstem response in pediatrics. Otolaryngol Clin North Am. 1989;22(3):473–500.

[5] Zahnert T. The differential diagnosis of hearing loss. Dtsch Arztebl Int. 2011;108(25):433.

[6] Rahmani Z, Mokhtarinejad F, Bazgir N, Kordjazi M, others. Evaluation of the Relation between Tuning Fork Tests, Glue ear Presence, and Conductive Hearing Loss in Patients with Otitis Media with Effusion. J Otorhinolaryngol Facial Plast Surg. 2022;8(1):1–8.