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Glue Ear and Grommets

Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

What is glue ear?

Glue ear is fluid in the middle ear, behind the ear drum. Some other names you may hear glue ear called are Otitis Media with Effusion or maybe Mucoid Otitis Media.

How did it get there?

The lining of the middle ear 'sweats' fluid all the time and this fluid usually empties out automatically when our ears "pop", for example when we swallow or yawn. When a middle ear infection or a head cold occurs this fluid may not be able to empty out as it normally would. The fluid is thin at first, but if the middle ear stays inflamed the fluid can't get out and air also can't get in, this fluid may become thick, like glue.

Air would normally enter the middle ear through the Eustachian tube, which is a tube that runs between the middle ear and the back of the nose, and is closed but opens for a moment every time we swallow. If the Eustachian tube is not working properly, such as from swelling from an infection, for example a head cold, it may not allow air to get into the middle ear, or the fluid to get out.

This thick fluid is the "glue" in glue ear.

How could this glue affect my child?

Your child hears poorly through this thick fluid and may seem deaf (and need the TV up louder) or seem inattentive, off-balance or irritable. If this occurs then your child needs to see your family doctor.

The reason this build up of fluid affects your child's hearing is that the tiny bones of hearing and the ear drum can not move freely because of the thick fluid. This is called a conductive hearing loss.

Children should not be left for long periods with untreated glue ear. The hearing loss which occurs in this case may affect your child's speech development, understanding of language, reading and spelling.

How can it be treated?

If your child normally has good hearing and speech, your family doctor may prescribe antibiotics but will usually wait a few weeks, checking your child frequently to see that the fluid disappears naturally. The amount of time this takes can depend on how long the fluid has been present. If the middle ear fluid does not disappear or if your child has hearing loss or speech problems, your family doctor may refer you to a specialist.

Your child may need grommets (tiny tubes) put in the eardrum to let air into the middle ear and allow the fluid to drain.

What are grommets?

Grommets are very small ventilation tubes made of plastic that are about 2mm in width. The grommet sits in the eardrum with one flange sitting on the inside and one on the outside of the eardrum.

Grommets are known by a few different names but they all work in the same way to allow air into the middle ear. Some of the other names are, ventilation tubes, drainage tubes, Shepard's tubes, Collar button tubes and T- tubes, you may hear other names as well so ask your doctor to explain this to you.

How do they work?

Grommets are ventilation tubes which have a small hole in the centre which allows fresh air to enter the middle ear to keep it free of fluid.

Once air can enter the middle ear it helps to improve your child's hearing by allowing the tiny bones of hearing to move freely again.

The grommets will gradually fall out of the drum after three - eighteen months. Most children's hearing will recover fully. The fluid may come back in some children and further treatment will be needed. Some children need grommets again.

Will my child need to go to hospital to have grommets inserted?

Yes, your child will need to be in hospital to have the grommets inserted. It is a day only procedure so they will not need to stay overnight unless your child is having another operation at the same time.

Your child will come into hospital the day they are having their operation. It is important that they don't have anything at all to eat or drink before the operation. The hospital will advise you what time your child needs to be 'nil by mouth'.

Before the operation commences your child will be given an anaesthetic to put them into a deep sleep so that they will not feel any discomfort during the procedure.

After surgery your child will be able to go home within a couple of hours, when they have woken up and had something to drink.

What do I need to know about grommets when at home?

Your child shouldn't have too much pain after the operation, if they do have a lot of pain or discharge from the ear which continues for longer than a few days you should contact your doctor.

After your child has the grommets inserted you need to maintain "water precautions" until the grommets have come out of the ear drum and it is fully healed.

It is very important that you maintain water precautions with your child to keep dirty water containing germs out of their middle ear while they have grommets. Dirty water is water that is hard to keep free from bacteria, for example heated pools, spas, rivers, creeks, lakes and dams.

Bath water is also dirty water so your child should wear ear plugs in the bath if they are going to put their head under water.

There are a few different things you can use as ear plugs

• Custom made ear plugs can be made by hearing aid suppliers
• Soft plastic plugs can be bought at some shops
• Silicone ear putty
• Blu-tack
• Cotton wool smeared with Vaseline

It is important that if you use putty or blu-tack that you use a piece as big as your child's outer ear and not a piece small enough to get stuck in the ear canal.

Can we still go swimming?

Yes, but not for the first 2 weeks after the operation. After that you should keep dirty water out of the child's ears. When they are swimming they will need the ear plugs and a swimming cap or ear wrap to hold the plugs in place while they swim.

What if water gets in my child's ears while the grommets are there?

Chances are nothing will happen. But an ear infection can develop with discharge from the ear and hearing loss needing treatment straight away with ear drops and possibly antibiotics. Sometimes further surgery is needed because of the infection. Your child will not be able to swim until the infection is gone.

Swimming with an ear infection is not only silly for your child; it can also spread the infection to other people.

Do I need to know anything else?

Because hearing loss occurs in glue ear, it is very important that your child has a hearing test after the glue ear is better. This is available in some hospitals, community health centres, in some ear, nose and throat specialists' offices or at Australian Hearing Services. If hearing is not back to normal, further investigation is needed.

If your child has grommets they will need to have their ears checked regularly to see if the grommets are still in the ear drum and still working.

• Glue ear should not be left untreated for long periods of time.
• Your child should have a hearing test after they have their grommets.
• Your child should use water precautions when swimming in dirty water or in the bath until the grommets are out.

The Children's Hospital at Westmead Tel: (02) 9845 3585 Fax: (02) 9845 3562 www.chw.edu.au	Sydney Children's Hospital, Randwick Tel: (02) 9382 1688 Fax: (02) 9382 1451 www.sch.edu.au	Kaleidoscope, Hunter Children's Health Network Tel: (02) 4921 3670 Fax: (02) 4921 3599 www.kaleidoscope.org.au