Paediatric Hearing - Otitis Media with Effusion (Glue Ear)

What is it?

Otitis Media with Effusion (OME), also known as, Glue Ear is a condition characterised by a collection of fluid within the middle ear space without signs of acute infection. OME may be associated with significant hearing loss, especially if it is bilateral and lasts for longer than 1 month.

Causes

Over 50% of cases are thought to follow an episode of acute otitis media, especially in children under 3 years of age
Persistence OME may occur because of one or more of the following:

Impaired eustachian tube function causing poor aeration of the middle ear.
Low-grade viral or bacterial infection.
Persistent local inflammatory reaction.
Adenoidal infection or hypertrophy.

Symptoms

Muffled hearing (most common)
Difficulty understanding speech, especially in noisy environments
Earache (less common)
Speech and language delays in children

Assessment

1. Detailed history

Examining a child's medical history helps diagnose OME.

Key points

Newborn hearing test: Checks for pre-existing hearing issues.

Hearing loss

Difficulty understanding speech, especially in groups.
Frequent requests to repeat things.
High TV volume.

Ear discomfort

Mild, occasional pain.
Feeling of ear fullness or popping.

Tinnitus

Ringing or buzzing in the ears.

Ear discharge

Persistent, foul smell requires immediate medical attention.

Infections: Frequent ear infections, colds, or nasal congestion can increase risk.

Allergies: May contribute to Eustachian tube issues.

Sucking habits: Prolonged thumb sucking, pacifier use, or bottle feeding can be risky.

Snoring: May indicate breathing problems affecting the middle ear.

2. Examining with an otoscope is helpful, but a normal appearance doesn't rule out OME:

Signs of fluid build-up (effusion) are more likely if the eardrum shows:

Abnormal colour: Yellow, amber, or blueish tinge.
Disrupted light reflex: Light reflection appears weak or scattered.
Cloudy appearance: Eardrum looks hazy beyond normal scarring.
Air bubbles or fluid line: Visible air trapped within the fluid.
Shape changes: Eardrum appears sunken (retracted), pushed inward (concave), or bulging outward.

Examine to assess for other factors that may predispose the child to OME including: Craniofacial anomalies, for example, Down syndrome and cleft palate, adenoid hypertrophy, asthma (including the presence of wheeze or dyspnoea), eczema or urticaria, conjunctivitis.

3. Assess the severity of the hearing loss and the impact on the child’s life and developmental status by asking about the following:

Fluctuations in hearing.
Lack of concentration or attention, or being socially withdrawn.
Changes in behaviour.
Listening skills and progress at school or nursery.
Speech or language development.
Balance problems and clumsiness.

Management

For children with OME without hearing loss, provide reassurance that it will often get better over time and that no treatment is necessary. 50% of cases will resolve spontaneously within 6 weeks.
If OME with hearing loss referral to audiology for formal assessment with tympanometry and hearing testing.

The following pharmacological treatments are NOT recommended for treating OME, as there is no evidence to support their use:

Antibiotics, antihistamines, mucolytics, decongestants, corticosteroids, leukotriene receptor antagonists, proton-pump inhibitors or anti-reflux medications.

Treatment can be grommet insertion.

If they have the surgical option of grommet insertion, the following is advice for treatment of infection/otorrhoea after grommet insertion: Grommets usually stay in place for 6-12 months then fall out.

water precautions should be taken to keep the ear dry (such as avoiding swimming, and taking care when bathing or washing hair)
use ear plugs or headbands if in contact with water
consider ciprofloxacin for 5 to 7 days

Children should be followed up periodically by a GP when discharged from ENT or sooner if symptoms re-occur. If any concerns, their hearing should be re-assessed by an audiologist. If symptoms of OME recur, refer the child back to an ENT specialist.

Support for the child in the environment

Being close to and facing the child when speaking to them.
Minimising background noise.
Using visual aids.
Informing their teacher that the child has OME, and asking if adjustments can be made in school to help (for example, taking the steps above and having the child sit near the front of class).
Preparing the child for interventions and ongoing management.

Deafness and hearing loss toolkit