WHAT IS OTITIS MEDIA WITH EFFUSION?
Otitis media with effusion, also known as glue ear, is a build-up of fluid in the middle ear that may occur as a result of a cold, sore throat, upper respiratory tract infection or Eustachian tube dysfunction.
The Eustachian tube links the middle ear with the back of the throat. If this becomes blocked fluid can build up behind the ear drum.
Otitis media with effusion is most common in young children although it can occur in adults.
WHAT ARE THE SYMPTOMS OF GLUE EAR?
The most common symptoms are; hearing loss, poor listening skills, hearing fluctuation, inattention and behavioural problems, balance problems and clumsiness, speech delay and recurrent ear infections.
HOW IS IT DIAGNOSED?
Otitis media with effusion is diagnosed after discussion with your consultant about the patient’s medical history, thorough examination of the ears internally with an otoscope and a hearing test.
In adults a flexible nasoendoscopy to examine the postnasal space, or nasopharynx, where the opening of the eustachian tube is located, may be carried out.
WHAT IS THE TREATMENT FOR OTITIS MEDIA WITH EFFUSION?
In a significant proportion of patients, symptoms in children with otitis media with effusion will resolve spontaneously after 3 months. If improvement is not seen after 3 months, a further period of active monitoring may be recommended to include repeat hearing tests. However, if symptoms are persistent and speech development and/or progress at school is affected, active treatment would be recommended.
Treatment may take the form of a hearing aid, or surgery may be considered, to include insertion of grommets +/- adenoidectomy. Grommets are ventilation tubes which alleviate the symptoms of otitis media with effusion by allowing the fluid to drain from the middle ear and for middle ear pressures to equalise with the atmospheric pressures. Grommets usually remain in place for 6 to 18 months after which they naturally extrude and the otitis media with effusion is expected to have resolved.
Adenoids are lymphoid tissue behind the nasal passages in the roof of the nose and if enlarged may obstruct the eustachian tubes, causing repeated ear infections and otitis media with effusion.
WHAT ARE THE POTENTIAL COMPLICATIONS FROM GROMMETS INSERTION AND ADENOIDECTOMY?
As mentioned previously, grommets are naturally pushed out of the ear drum in most patients, so their effects are temporary. Once grommets extrude, the otitis media with effusion could recur, requiring repeat grommet insertion.
There is a 3% risk of permanent ear drum perforation after the grommet is pushed out, and whilst the grommet remains in place, the patient has to observe strict water precautions with either silicone or cotton wool + Vaseline ear plugs, to prevent water getting into the ears. There is also a risk of infection with grommet insertion, that may be difficult to treat with antibiotics, necessitating grommet removal. Other uncommon surgical risks from grommets insertion include bleeding and hearing loss. Removal of the adenoids may be associated with significant bleeding in a small proportion of patients.