Glue Ear: Guide

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Cause of Glue Ear

Pressure in the middle ear is regulated by the Eustachian tube, a narrow tube which connects the middle ear to the back of the nose and throat.  When we swallow the Eustachian tubes open to allow fresh air to enter into the middle ear.  Fluid in the middle ear can occur with Eustachian tube dysfunction.  The fluid build up is called an effusion and it is much more likely to occur in children due to the anatomy of their Eustachian tube.

In adults, the Eustachian tube develops and becomes wider with a steeper angle. In children however, the Eustachian tube is narrower and more horizontal, so it does not drain as effectively as in adults.

If the Eustachian tube closes, fresh air can no longer reach the middle ear and the pressure falls.  The lining of the middle ear secretes a fluid, which can be thin and watery or a thicker glue-like substance.

This animation explains how we hear and illustrates how the middle ear can become filled with fluid as a result of Eustachian tube dysfunction. The NHS website provides information about glue ear and an animation that explains what glue ear is, what causes it and how it is treated.

Ear infections can cause middle ear fluid/Glue Ear but most cases aren’t due to infection.

Studies have shown that Glue Ear is less likely to clear when a child is exposed to smoke from one or both parents (Maw et al.1992).  There is an increased risk of middle ear infections with both prenatal and postnatal smoking (Royal College of Physicians 2010).

Breastfeeding reduces the risk of Glue Ear.  The reasons are unclear, but it is possible that proteins contained in breast milk reduce Eustachian tube inflammation.

Down’s Syndrome
Many children with Down’s syndrome have smaller Eustachian tubes and are more likely to get Glue Ear and an associated hearing loss.  The NDCS has produced a useful factsheet about this and further information about Down’s syndrome and childhood deafness.                           

Cleft Palate
Children with a cleft palate are more likely to have Glue Ear.  For children under the age of one with cleft palate, 92-97% will have Glue Ear (Kubba et al. 2000).  The high incidence of Glue Ear in cleft palate is thought to be due to Eustachian tube dysfunction. Most cleft children with hearing loss due to Glue Ear will have hearing aids early on and grommets may be considered later.  Phua et al. (2009) recommended that grommet insertion should not routinely take place, but is appropriate if there have been ear infections or a hearing loss.  The Cleft Lip and Palate Association (CLAPA) provide information about hearing and Glue Ear.
A care pathway has been developed by NICE (2008) for children with cleft palate. Care pathway 3. Children with cleft palate - NCBI
Insertion of ventilation tubes at primary closure of the cleft palate should be performed only after careful otological and audiological assessment.
Parents of children with a cleft palate, explain how it affected their child’s hearing.


Bupa (2013) ‘How Glue Ear develops’ .Online animation. 

Kubba, H., Pearson, J., Birchall, J. (2000) ‘The aetiology of otitis media with effusion: a review’. Clinical Otolaryngology, Volume 25, Issue 3, June pp. 181-194

Maw, A., Parker, A., Lance, G., Dilkes, M. (1992) ‘The effect of parental smoking on outcome after treatment for Glue Ear in children’. Clinical Otolaryngology and Allied Sciences, Volume 17, Issue 5

Phua, Y.S., Salkeld, L.J., de Chalain, M.B. (2009) ‘Middle ear disease in children with cleft palate: Protocols for management’. International Journal of Pediatric Otorhinolaryngology Volume 73,  Issue 2, pp. 307-313.

Royal College of Physicians (2010) ‘Passive smoking and children: a report by the Tobacco  Advisory Group of the Royal College of Physicians. [Online] Available at : [Accessed: 9 Sept 2023].