Glue Ear
Date issued: February 2025
Date reviewed: February 2027
A-277/SH/ENT/Glue Ear v8
What is glue ear?
Glue ear is a very common condition, affecting mainly children, where thick sticky mucus builds up behind the eardrum. In some children it causes hearing problems. They may also develop, as a result, problems with speech, behaviour and education.
In a lot of cases glue ear will clear up by itself and will not require any treatment. However, if it has persisted for more than 3 months, then most doctors and audiologists would feel that it may require intervention.
What causes glue ear?
The reason children tend to get glue ear is because the tube that normally drains the mucus away (the Eustachian tube) does not work very well. Some children are more prone to glue ear than others.
Managing glue ear
- A period of watchful waiting
- Use the Otovent Balloon
- Temporary hearing aids
- Grommet surgery
Watchful waiting
Glue ear will often resolve on its own so the first course of action when glue ear is identified is to wait a period of 3 months to see if it clears by itself.
After this period the NICE guidance recommends managing glue ear if it affects both ears over a period of 3 months with a hearing level in the better ear of below 20 dBHL averaged at 0.5, 1, 2 and 4 kHz (your Audiologist will let you know if this is the case).
If the glue ear persists for more than 3 months there is still a good chance it will get better by itself in time, but how long this will take cannot be predicted; it may take years. In some cases hearing will not be significantly affected and parents may feel that their child is coping very well and do not want them to have any treatment other than regular hearing tests. At any stage if this changes we can intervene with either grommet surgery or temporary hearing aids.
Otovent® (Autoinflation)
For all children aged 3 and over who are found to have glue ear, we recommend the use of an Otovent® balloon 2-3 times daily during the 3 months between the initial hearing test (when the glue ear was diagnosed) and the follow up test.
The Otovent® Method
Otovent is a small nasal balloon which the patient blows up using their nose. Otovent equalises the pressure and helps relieve the symptoms of glue ear in the middle ear. The act of blowing the balloon up helps to open up the Eustachian tube, making it easier for fluid to drain from the middle ear. Children can use Otovent at home under parental supervision. It is painless, harmless and takes only a matter of seconds to perform. Otovent should be used 2-3 times daily for a period of 2-3 weeks. Patients will often start to see results as early as a few days into using the Otovent.
We are not able to prescribe this, it is widely available online and in pharmacies for £10-15. Find out more about Otovent for Glue Ear
Each pack of Otovent contains:
1 x Nosepiece
5 x Balloons
1 x Carry Case
Temporary hearing aids
A hearing aid can help a child overcome the hearing loss associated with glue ear. It will give the condition chance to resolve on its own, without having surgery (grommets).
During the appointment, if a hearing aid is opted for the audiologist will discuss the styles available.
For younger children hearing aid usage requires a lot of effort on the part of the parents, and may be challenging for the parents and child to keep it in.
Types of Hearing Aid
There are two different types of hearing aid, a Behind The Ear (BTE) hearing aid and a bone conduction hearing aid (this can either be worn on a soft band or a sticker), which are both suitable for children with glue ear.
Behind The Ear (BTE) hearing aid
This hearing aid is worn behind the ear and is held in place with a custom made ear mould.
Advantages of a BTE hearing aid:
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There is a greater sound quality and improved frequency range when compared to the soft band bone conduction hearing aid
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Potentially more comfortable
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Aesthetically more pleasing
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The hearing aids are Bluetooth compatible so can be connected to most apple and android devices for direct streaming
Disadvantages of a BTE hearing aid:
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As hearing levels tend to fluctuate with glue ear, the output of the hearing aid might not always be accurate (use of a volume control can help with this)
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More frequent follow up appointments are required (every three months following fitting, until glue ear has resolved)
Softband bone conduction hearing aid
This hearing aid is worn on a headband which holds the hearing aid in place on the skull.
Advantages:
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Due to the design of the hearing aid it will always give right amount of amplification for this type of hearing loss (it sends the sound through the bone around any glue ear) so children will always hear well regardless of any fluctuation in hearing
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Less frequent follow up appointments are required (every six months following fitting, until glue ear has resolved)
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This hearing aid is Bluetooth compatible and can connect to apple devices for direct streaming
Disadvantages:
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Some children find headband is too tight
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Aesthetically less pleasing
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There is a slightly reduced sound quality and narrower frequency range when compared to the BTE hearing aid
ADHEAR Bone Conduction Hearing Aid
This hearing aid is worn on a sticker behind the ear which holds the hearing aid in place on the skull, it can also be worn soft band.
Advantages:
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Due to the design of the hearing aid it will always give right amount of amplification for this type of hearing loss
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Less frequent follow up appointments are required (every six months following fitting, until glue ear has resolved)
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When worn on the sticker there is no feeling of pressure on the skull
Disadvantages:
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These hearing aids are not blue tooth compatible
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For the sticker to last and be secure the skin needs to be prepared and the sticker placed on 20 minutes before the device can be worn
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Some patients find that the sticker doesn’t last and has to be replaced regularly
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There is a slightly reduced sound quality and narrower frequency range when compared to the BTE hearing aid
Grommets
What are grommets?
Grommets are a surgical option to managing glue ear. A grommet is a tube that sits in a small hole in the eardrum. It can be made of plastic or metal. The most commonly used type is a plastic bobbin. Grommets are often recommended for the treatment of glue ear or recurrent ear infections.
What does the operation involve?
Anesthetic
Grommets in children are always inserted under general anesthetic. This means your child will be asleep throughout the procedure and will not feel anything.
Approach
Grommets are inserted through the ear canal. There are, therefore, no external scars.
Procedure
A small hole is made in the eardrum, and the thick mucus is removed. The grommet is then placed in the hole. The procedure takes about 10 minutes to perform, with additional time for going to sleep and waking up.
Dressings
No dressings or bandages are required. Your surgeon may sometimes place a small piece of cotton wool in the ear canal if there has been any bleeding.
Aftercare
You will normally be able to take your child home on the day of their operation, once they have recovered from the effects of the anesthetic.
Follow up
Most grommets will fall out by themselves. Most plastic bobbin grommets last about 9 months, although some can fall out very early, and some may stay in longer.
When the grommets have fallen out, the Eustachian tube will usually have started to work better and the glue ear will not return, but in about 1 in 5 cases, the glue will come back and further grommets may need to be inserted.
Does my child need to take time off school?
Your child will normally be able to go back to school on the day after their operation.
Are there things I must not do afterwards?
We would normally recommend that you try to keep water out of your child’s ears for 2 weeks following their operation. After this surface swimming is fine and but it is advised to keep the ears as dry as possible. Swimming ear plugs are an option.
Are there any complications?
Most operations are successful, and there are generally very few problems.
However, every operation has risks and these need to be understood before you agree to go ahead with treatment. These risks fall into 3 categories:
Complications of the anesthetic
Your anesthetist will discuss the anesthetic with you before your operation.
Complications that can affect any operation
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Pain: which occurs with every operation. Having grommets inserted is usually not very uncomfortable, and most children will be pain free with paracetamol, if they need anything at all.
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Bleeding: this can occur during or after an operation. Bleeding from the ears can occur after grommets insertion but is usually of no significance and settles by itself.
Complications that are specific to grommets insertion
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Ear discharge: this is not uncommon after grommets are inserted, affecting up to 1 in 3 children. If it lasts more than a day or two your child may need their GP to see if antibiotics are required.
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Small hole left in the eardrum: when a grommet falls out, the eardrum usually heals up after it, but sometimes a small hole is left behind. This can affect up to 2 in 100 children with plastic bobbins.
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Grommet blockage: sometimes blood or mucus can dry in the hole in the middle of a grommet and block it up. They can often be unblocked with eardrops but will sometimes need to be removed or replaced.
What will happen before my operation?
Two to three weeks before your child’s operation, they will be invited to attend a pre-operative assessment clinic (PAC). This is a clinic run by one of the doctors and a nurse on either Wildgoose Ward on level 12, or at the Plym Day Surgery Unit. Both are at Derriford Hospital. The purpose of this clinic is to assess your child’s fitness for surgery, to request any necessary tests (e.g. repeat hearing test, X ray, ECG “heart tracing”, blood tests). You may also be asked to sign a consent form that gives the surgeon permission to carry out your child’s operation.
What happens on the day of my child’s operation?
On the day of your surgery, your child will be required to attend either Wildgoose Ward or Plym Day Case Unit again. You will be asked to wait in the admissions area until a bed is ready, when one of the nursing staff will admit your child. Your child’s anesthetist and a member of the surgical team will also see you to answer any questions and to confirm you still wish to go ahead.
If you have any questions about any of the options discussed in this leaflet please ask your Audiologist.
