Glue ear can be a distressing condition which can cause long term hearing loss and/or speech difficulties. It is becoming more common overseas, for doctors to avoid prescribing antibiotics for ear infections. This policy is due to an attempt to avoid breeding so-called superbugs. It is estimated that approximately 80% of ear infections will resolve themselves within three days without treatment. However it is still quite controversial to avoid prescribing antibiotics and in New Zealand antibiotics are usually prescribed. Paracetamol is usually prescribed to assist in reducing the pain.
Over 30 million prescriptions are written each year for antibiotic treatment of ear infections. In the United States alone, ear infections account for 25% of all antibiotics prescribed. There are limitations to antibiotic treatment however, between 30% - 50% of ear infections are the result of a viral infection. Antibiotics are useless in the treatment of viral infections. To determine whether an ear infection is viral or bacteria in nature, a culture from the middle ear is required for lab analysis. Because this would be a rather invasive procedure, requiring a knife to make a small incision inside the ear, it is not a standard practise.
So just what is Glue ear? It occurs when fluid collects in the middle ear space. This usually happens after a cold or infection. The lining of the middle ear is naturally wet and the secretions normally drain away through the Eustachian tube and into the throat. When the Eustachian tube becomes blocked, then the fluid builds up in the ear drum. The fluid prevents the eardrum from flexing and if the fluid is there for a length of time it becomes thick like glue - hence the name Glue Ear. When the eardrum is unable to move properly it creates a hearing loss.
Glue Ear is also known as otitis media with effusion, secretory otitis media or serous otitis media (SOM). Glue Ear itself is not infection, the fluid in the middle ear does not contain germs or organisms, although the condition may start following a bad cold or ear infection.
In many cases, the condition clears up by itself. However Turner Syndrome girls are more susceptible to glue ear and ear infections. This is because the ear tubes tend to be shorter and because often the ears are set lower the Eustachian tubes are at a flatter angle, making it difficult for fluid to drain and makes it easier for bacteria to pass from the back of the nose and throat to the middle ear.
Ear infections are the result of bacteria or viruses, they lead to the accumulation of pus and/or mucus behind the eardrum, blocking the Eustachian tube. This causes earache, swelling and redness. Middle ear disease, including infections, account for about one third of visits to the GP in the first 18mths of life. Glue Ear is the most common reason why children undergo surgery involving general anaesthetic.
It is important to diagnose Glue Ear as early as possible because it can often cause a hearing loss at a crucial time in a child’s speech development. Often children have Glue Ear at age 2yrs, but it does not become apparent till they are 5yrs old and their speech difficulties are highlighted at school.
Girls with Turner Syndrome should have regular hearing checks. Even if they are not experiencing regular ear infections, hearing checks will give a baseline to compare future hearing tests with. It is also important to realize that although your daughter may not have ear infections, she can still have glue ear. To determine whether your child has fluid in her ears you can get a simple test done, called a Tympanogram, your GP or nurse should be able to do this test. It is painless and only takes a minute or two.
The symptoms of Glue Ear are varied, and it is quite possible you may be unaware your child has any problem. The most important symptom is deafness, which in turn can cause poor performance at school or behavioural problems such as irritability or naughtiness, which are out of character for your child. Earache is another common symptom, although it is not usually as severe as with an ear infection. In younger children, failure of language development can be a sign of Glue Ear.
Surgical treatment of Glue Ear involves making a small hole in the eardrum (myringotomy). The child is given a light general anaesthetic. The fluid is sucked out through the hole and in most cases a grommet (a tiny tube) is inserted to keep the hole open. The operation usually takes about 15mins to perform. Opinions vary on how useful it is to remove the adenoids and the size of the adenoids can be assessed during this procedure. If there has been a lot of mouth breathing because of nasal blockage, recurring infections, or repeated grommet insertions then an adenoidectomy can be helpful.
The grommets can stay in place for some time, usually around 6-9mths, sometimes much longer. As the eardrum grows behind the grommet, the grommet is pushed out into the outer part of the ear. It can safely be left there, and will fall out on its own. If the fluid returns after the grommet has fallen out, then reinsertion of the grommets may be required. This is a common situation for Turner Syndrome girl, since often they do not grow out of the condition and may need grommets into adulthood. However this is dependent on the individual girl. The hole in the eardrum usually repairs itself with no consequence. Some cases of scarring of the ear drum can occur as a result of grommet insertion, but this is often preferable to prolonged periods of deafness in childhood, and rarely results in a significant loss of hearing in later years.
In the past children with grommets were forbidden to participate in swimming. Over recent studies involving two groups of children - one group allowed to swim and the other not allowed to swim - showed the children in the swimming group had slightly less ear infection and discharge. Advice will vary depending on your surgeon, some doctors will still want your child to avoid swimming, while others will recommend that swimming without ear protection should be encouraged, but diving and swimming below the water should be actively discouraged. The reason being that with deep diving water is pushed through the grommet by the pressure created.
Flying is actually easier with grommets, as the air pressure equalizes through the grommet.
There are some things we can do to help prevent ear infections.
By Leanne Beard