What is glue ear?

The ear is made up of three parts: the external ear, the middle ear, and the inner ear. The middle ear is a air-filled space behind the ear drum which contains the three little bones of the ear. These allow transfer of sound to the inner ear. Glue ear is a collection of thick fluid that accumulates behind the ear drum (in the middle ear). It looks like glue and has a similar consistency. A negative pressure is created and this sucks back the ear drum and stops drainage of fluid from the middle ear to the nose via the Eustachian tube. It most commonly occurs in young children. It causes a decrease in hearing, and this can be a problem in young children, that rely on hearing well in order to develop good speech.

It can start after a cold or ear infection, or in those children with large adenoids. Children with Down’s syndrome also commonly get glue ear, as well as children that live in smoking households.

How do we treat glue ear?

We often take an expectant approach to this condition as it will quite often resolve spontaneously over a few months without treatment. We bring back the child for a repeat hearing test to ensure things have got better. Some surgeons will prescribe a long course of antibiotics, the idea being that bacteria are to blame. Some will ask the child to repeatedly pinch the nose, close the mouth, and to try to force air up from the lungs. This pushes air from the back of the nose, through the Eustachian tube into the middle ear. An alternative way of doing this is using a device called “otovent” which is a balloon which the child can blow up with the nose.

When all these tactics fail, and the child still has considerable hearing loss several months down the line, then we may consider placing grommets. These are very small plastic tubes with a hole in the middle. When placed in the ear drum, air can enter the middle ear. This releases the negative pressure build up, and allows the fluid to drain down the Eustachian tube to the back of the nose, thus improving hearing. There are other reasons why we put in grommets too, but we will leave that for another day.

How do we put in grommets?

In children, a general anaesthetic is necessary. We use a microscope to visualize the ear and remove any wax. The ear drum then become visible. We make a small microscopic cut in the ear drum using a fine small knife. We then use fine suction to remove any ‘glue’ from behind the ear drum. Then we insert a grommet. This operation is sometimes combined with adenoidectomy, as that helps uncover the opening to the Eustachian tube in the back of the nose. That’s it!

Recovery

Putting in a grommet is a quick operation. Normally, children can go home the same day. It is probably a good idea to stay at home for a number of days after the operation.

Follow up

We normally make an appointment to see you for a repeat hearing test after 6 to 8 weeks, and then see you every 3 to 6 months until the grommets fall out. This varies from hospital to hospital.

Complications and aftercare

It is not a particularly painful operation, and once the grommets are in you won’t feel them being there. Bleeding is unlikely due to the microscopic cut made. It is possible to get infections in the middle ear afterwards, and this would manifest with yellow or green pus dribbling out of the ear. If this happens you will need to either see the GP or an ENT surgeon to get some antibiotic ear drops to use for a week or more. Some of the drops ENT surgeons prescribe have a leaflet which mentions that they should not be used in case of a perforated ear drum, but we as ENT surgeons still use them to good effect in children with infections after grommets. Of course, there are also risks associated with having a general anaesthetic, but anaesthetics have become pretty safe nowadays.

There is a great deal of controversy surrounding getting water in the ears after grommets. Some surgeons believe that getting water in the ears and swimming is fine, but most will say to keep the ears meticulously dry for as long as the grommets are in. This helps prevent infections. When having a shower, dip a large piece of cotton wool into some Vaseline and place this outside the ear canal. This creates a watertight seal. Use a new piece next time. Don’t swim for 6 weeks and then only with cotton wool and Vaseline protecting the ears with a headcap. Don’t dive or put the head underwater. Earplugs may get coated with bacteria and cause infections, so using a new piece of cotton wool is better. Under no circumstances try to clean the ear using cotton buds or any other makeshift implement. This can definitely predispose to getting infections. In the past it was said that nothing smaller than an elbow should go in anyone’s ear!