Glue ear: symptoms, treatment, grommets and how long it lasts

The NHS describes glue ear as where the middle part of the ear canal fills up with fluid, which can cause temporary hearing loss. NICE guideline NG233 uses the medical name otitis media with effusion (OME) and notes that it is also known as glue ear. The NHS says it is much more common in children, but adults with glue ear have the same symptoms.

NICE says OME can fluctuate and that information given to families should cover what it is, its cause, its fluctuating nature and its possible impact on the child's hearing, listening, language development, behaviour, and emotional and social wellbeing.

The NHS says the most common symptom is temporary hearing loss, which can affect both ears at the same time. Other symptoms may include earache or ear pain, hearing sounds such as ringing or buzzing (tinnitus), and problems with balance. If glue ear lasts a long time, it can affect a child's speech development and progress at school.

NICE guideline NG233 lists features children with OME often present with: hearing difficulties such as mishearing when not looking at who is speaking, difficulty in a group and asking for things to be repeated; delayed speech and language development; ear discomfort; and tinnitus. It says behavioural problems, particularly lack of concentration or attention, being withdrawn, irritability or poor educational progress, and balance difficulties such as clumsiness can also be associated with OME.

The NHS says to see a GP if your child has signs of a hearing problem, such as:

• Speaking loudly.

• Being difficult to understand.

• Asking people to repeat what they say.

• Asking for the TV or music to be turned up loud.

• Struggling to hear people far away.

• Becoming easily distracted when people are talking.

• Finding it hard to concentrate or seeming tired and irritable because it is harder for them to listen.

The NHS says glue ear usually clears up within 3 months, and that it often clears up on its own. If a child has had glue ear for more than 3 months, they may be referred to a specialist for hearing tests. The NHS says a child may be monitored for up to a year in case their symptoms change or get worse.

NICE guideline NG233 advises reassessing hearing after 3 months in bilateral OME (both ears) with hearing loss. At that reassessment, if OME is present but with no hearing loss, the child is discharged and parents are advised to seek reassessment if new concerns develop.

The NHS says glue ear is not always treated. The GP will usually wait to see if symptoms get better on their own, because there is no effective medicine for glue ear and it often clears within 3 months. NICE guideline NG233 says that for children with OME without hearing loss, reassurance that it will often get better on its own is appropriate and no treatment is necessary.

For children with confirmed OME and hearing loss, NICE says to discuss the options using a decision table, covering monitoring and support, autoinflation, hearing aids and grommets, and supportive strategies.

NICE guideline NG233 says not to offer antibiotics to treat OME, and not to offer oral or nasal corticosteroids, antihistamines, leukotriene receptor antagonists, mucolytics, proton pump inhibitors, anti-reflux medicines or decongestants for OME or OME-related hearing loss. It also says not to use homeopathy, cranial osteopathy, acupuncture, dietary modification including probiotics, or massage.

The NHS says antibiotics may be prescribed if glue ear causes an ear infection, which is a separate problem.

The NHS says a grommet is a small tube placed in your child's ear during surgery that drains fluid away and keeps the eardrum open. It should fall out naturally within 6 to 12 months as the ear gets better.

The NHS says a child may be referred to a specialist if glue ear symptoms are affecting their learning and development, if they already had severe hearing loss before glue ear, or if they have Down's syndrome or a cleft lip and palate, as glue ear is less likely to get better by itself. The two main treatments are temporary hearing aids or grommets, and occasionally adenoids are removed.

NICE says the risks of grommets include perforation of the eardrum, localised atrophy, tympanosclerosis and infection.

The NHS says a GP should be able to tell if it is glue ear by looking for fluid inside the ear with a small scope with a light and magnifying glass, which should not be painful. NICE guideline NG233 says formal assessment should include otoscopy, general upper respiratory health, general developmental status, hearing testing and tympanometry.

NICE guideline NG233 advises parents and carers to avoid exposing their child to tobacco smoke because it may increase the risk of developing OME. It also suggests supporting a child with OME and hearing loss by being close to and facing them when speaking, minimising background noise, using visual aids and telling their teacher so adjustments, such as sitting near the front, can be made.

On the NHS, glue ear is assessed by a GP and, if it persists or affects hearing and development, by audiology and ENT services, which provide hearing tests, hearing aids and grommets.

Private ENT and audiology services can also offer assessment, hearing tests and surgery. Whichever route you take, ask what the hearing test showed, whether watchful waiting is reasonable, and what support the school should have in the meantime.