Glue Ear - Picture Summary

1. Normal ear and hearing

• Sound waves hit the eardrum which cause the eardrum to vibrate.
• Vibrations of the eardrum pass on to tiny bones (the ossicles) in the middle ear - the malleus, incus and stapes. These transmit the vibrations to the cochlea in the inner ear.
• The ear nerve (auditory nerve) takes sound signals from the cochlea to the brain.

• The middle ear space behind the eardrum is normally filled with air.
• This air space connects to the back of the nose by the Eustachian tube.
• From time to time the narrow Eustachian tube opens to let air into the middle ear, and to drain any fluid out. This usually happens when we swallow or yawn.

2. Glue in middle ear

• Glue ear is a condition where the middle ear becomes filled with glue-like fluid.
• Glue ear is common, but the reason why fluid builds up is not clear.

• The main problem with glue ear is dulled hearing. The gluey fluid dampens the vibrations of the eardrum and bones in the middle ear.

3. Glue ear clearing away

• The usual advice at first is to wait to see if the fluid drains on its own and air returns to the middle ear.
• If the fluid goes and air returns to the middle ear then hearing returns to normal.

• Fluid drains and hearing is back to normal within three months in about half of cases.
• Hearing is back to normal within a year in more than 9 in 10 cases.
• Some children have several bouts of glue ear that cause short but recurring episodes of dulled hearing.

4. Treatment options

Watchful waiting ('wait and see')

No treatment is usually advised at first as the outlook is good. In many cases the gluey fluid clears away without any treatment - as described above.

Balloon treatment

For this treatment a special balloon is blown up regularly by the child using their nose. This is called 'autoinflation'. It puts back-pressure into the nose, and may help to open up the Eustachian tube and allow better drainage of the fluid. It tends to be tried in older children who can use the device to blow up the balloon.

Grommets may be advised if glue ear persists

• A grommet is like a tiny pipe that is put across the eardrum.
• A tiny cut is made in the eardrum under anaesthetic. The fluid is drained and a grommet is inserted.
• Grommets allow air to get into the middle ear.
• Hearing improves immediately.

• Grommets normally fall out of the ear after 6-12 months. By this time the problem with glue ear has often gone away.
• The hole in the eardrum made for the grommet normally heals quickly when the grommet falls out.
• Sometimes grommets need to be put in on two or more occasions if glue ear recurs.
• Sometimes the adenoids are also removed to improve the drainage of the Eustachian tube. Adenoids are similar to tonsils but lie at the back of the nose near the opening of the Eustachian tube.