Glue Ear and Grommets
The child's anatomy is such that small increases in the size of the glands at the back of the throat can cause the Eustachian tube to close. This is God's way of making life difficult for parents and if the hapless child has a particularly bad arrangement of glands, tubes and suffers viral infections, life can become very difficult for the child too.If the tube becomes blocked the middle ear, which is an air filled cavity (containing three of the tiniest bones in the body) becomes filled with a sticky gluey type of fluid. This happens because air pressure in the cavity falls as the air is absorbed into the lining of the cavity. With the tube blocked the body is unable to maintain the cavity at atmospheric pressure. Low pressure in this cavity causes fluid to exude into it. This is the so-called glue of glue ear. These delicate bones, so lightly balanced and eloquently placed, transmit vibrations from the ear drum to the cochlea where a beautiful mechanism of fluid, hairs and nerve endings give us the rich experience we call sound. These become damped and fixed so that a fractious mother shouting in the ear of the beaming child is perceived as a faint incomprehensible drone, instead of that request to wash your hands for dinner. Glue ear is therefore characterised by intermittent deafness.
As with most childhood ailments the spectrum of disease is vast. On the one hand a child may be temporarily rendered deaf during a particularly bad cold, whereas another may be more or less permanently deaf. It affects children from as young as 1 year to typically 5 or 6 years. However adults have similar problems, so the very truthful adage that they will grow out of it may not always be correct. The main reason for being aware of this condition is that if the child cannot hear language may not develop. They may miss the gist of what the teacher says or they may have behavioural problems. This excludes those problems associated with the condition, such as a constantly streaming nose and frequent ear infections, with or with out the offensive discharge. There is no single consensus as to the best method of treating this condition and obviously the treatment will vary with the severity as measured by such things as hearing loss, language development, behavioural problems and loss of effective schooling.
As there is no single effective treatment those proffered enter in and out of fashion. They range from anti-histamines, continuous low dose anti-biotics, tonsillectomy, adenoidectomy, grommets and nasal balloons. Oddly some children definitely benefit from some of theses, whereas some will benefit from none.
Grommets would seem to be the obvious solution. These are little plastic tubes that are inserted into the eardrum and create a passage from the middle ear to the outside. This overcomes the closed Eustachian tube as it allows the pressure to be the same on both sides of the drum. Any fluid that collects simple drains away. The ossicles can hum in the air and hearing is restored. These also have the advantage that if your child is prone to rupturing their ear drums, with every ear infection, then you are spared the howls of discomfort until the thing ruptures as all the puss flows away painlessly. The body hates foreign particles and so the grommets are extruded fairly frequently, often with in a few weeks. Combined with some disappointing results, and the fact that your child has to risk a general anaesthetic, makes the popularity of this procedure wane.
A more effective treatment is the nasal balloon. This consists of blowing up the balloon by closing one nostril and blowing through the other to inflate the balloon. This has the effect of raising the pressure at the back of the pharynx (nose and mouth), so forcing the Eustachian tube open and briefly equalising pressure whilst allowing the thick fluid to run out. Unfortunately results are very variable and it does not suit every one. Decongestants however, are the easiest to try and continuous low dose antibiotics are useful especially if frequent infections are a problem.
If you suspect your child is suffering with selective deafness you should perhaps consider glue ear as a cause. Characteristically it is intermittent, and often short lived, and in most cases no action is needed. However, if your child seems to suffer with long periods of intermittent deafness or has behavioural problems it is worth considering as a cause.
by Dr David Garwood
Patient UK: Glue Ear
eHealth MD: What is Glue Ear?
Royal National Institute for the Deaf
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