glue ear

Glue Ear can go unnoticed and unidentified in a young child.  It is not normally associated with pain, but children may experience a fullness or popping in their ears.

Glue Ear often occurs at a time when a young child is learning to communicate, may have a limited attention span and likes to do things their own way.  Picking up on symptoms related to Glue Ear at this point in a child’s development can be difficult.

Symptoms generally fall into the following four areas:

Acute otitis media and Glue Ear ‘are together responsible for sizeable costs of about £2-300 million annually, and reflect the magnitude of the problem to the NHS.’ (Williamson et al. 2006).

‘It is thought that between 50% and 85% of children experience at least one episode of AOM by 3 years of age with the peak incidence being between 6 and 15 months.’ (Qureishi et al 2014, citing Klein 1989 )

In some cases a child with Glue Ear may benefit from a low-powered hearing aid. Hearing aids can be worn for many months while waiting for Glue Ear to clear itself and may be preferable to surgical treatment.

Studies have shown that there is a ‘sensitive period for the development of central auditory pathways ... within the first 3.5 years of life when the central pathways show maximal plasticity’ (Sharma et al., 2009).

A child with Glue Ear may find it difficult to listen to speech and straining to listen may result in reduced attention.

Listening is a process that consists of four stages: detection, discrimination, identification and comprehension (Erber, 1982).

Speech tests can be used to see if a child is accessing the sounds of speech.

The McCormick Toy Test

The McCormick Toy Test was developed in 1977 by Professor Barry McCormick and consists of 7 pairs of words with the same vowel sound and different consonants.  It is important to know if the child understands the vocabulary, so any unknown words are not used.

Studies into the incidence of Glue Ear in pre-school children were carried out in the 1980s and 90s.  It is now well documented that a large number of children will have Glue Ear at least once before the age of four and as such there has been little recent research.

There is a high incidence of Glue Ear in the early years and studies have shown that for most children this will clear without intervention.  Glue Ear has been shown to improve in 78-88% of ears and as a result of this finding, guidance arose to wait 3 months before surgical intervention (Tos et al. 1982).  

cont

A grommet is a small ventilation tube that is surgically inserted into the eardrum to ventilate the middle ear.  The insertion of grommets for the treatment of Glue Ear is one of the most common operations performed under general anesthetic in childhood (Department of Health 2015).  Glue Ear normally resolves itself so guidelines state that there should be a 3 month period of persistent Glue Ear before surgical intervention should be considered.

Glue Ear is most common between the ages of 2 and 4 years.  During a critical period for language development, the frustration of not understanding or being misunderstood, can result in behavioural problems.  Wilks et al. (2000) found that 55% of pre-school children who had Glue Ear for 3 months or more, presented with behavioural problems.

A baby’s hearing is tested shortly after birth as part of the Newborn Hearing Screening Programme.  Children are not born with Glue Ear but it is common in the first year of life.

The two tests that may be used in the Newborn Hearing Screen are oto-acoustic emission and Automated auditory brainstem response.  Both of these tests are objective tests and do not require the baby to respond in anyway.  The auditory brainstem response test needs the baby to be asleep (either under natural sleep or sedated).