Chronic Otitis Media with Effusion (Glue Ear) in Children

Overview

Chronic Otitis Media with Effusion (OME), commonly referred to as “glue ear,” occurs when fluid accumulates in the middle ear without an active infection. It is called “glue ear” because the fluid can become thick and sticky, much like glue. This condition is common in young children and can lead to hearing problems, speech delays, and discomfort. Unlike acute otitis media, there is no pain or fever, but the persistent fluid can affect hearing and the normal functioning of the middle ear.

Symptoms

While children with glue ear typically don’t show signs of illness, common symptoms include:

  • Hearing difficulties: The most noticeable symptom is muffled or reduced hearing, which may affect your child’s ability to respond or follow conversations.
  • Speech and language delays: Hearing loss due to fluid buildup can delay a child’s speech and language development, especially if the condition is chronic.
  • Balance problems: Some children may experience slight balance issues due to the fluid in the ear affecting the vestibular system.
  • Behavioral changes: Children may become more withdrawn, less responsive, or frustrated due to hearing difficulties.

Causes and Risk Factors

Environmental Factors
Several environmental factors can increase the chances of developing otitis media with effusion, including:

  • Bottle-feeding or feeding while lying down.
  • Having siblings who have had ear infections.
  • Attending daycare.
  • Allergies to things in the environment (dust, pollen, etc.).
  • Lower income or socioeconomic status.
  • Exposure to secondhand smoke at home.
  • A family history of ear infections.

Age
Age is a key factor in otitis media with effusion. In infants, the eustachian tube (which helps drain fluid from the ear) is more horizontal than in adults, making it harder for fluid to drain properly. As children grow, the tube tilts to a more vertical position, improving drainage.

  • Children aged 2 to 4 years have the highest rates of otitis media with effusion, but it becomes less common after age 6.

Eustachian Tube Issues
Problems with the eustachian tube can lead to fluid buildup in the middle ear. This is common in:

  • Children with a cleft palate or Down syndrome.
  • Conditions like cystic fibrosis, where thicker mucus and poor mucus clearance can make fluid buildup more likely.

Diagnosis

Diagnosis of glue ear involves a physical examination and specific tests:

  • Lab Tests: 
    • Lab tests are rarely needed for diagnosing otitis media with effusion unless there’s suspicion of another condition. 
    • A detailed medical history and physical exam are usually enough to make an accurate diagnosis.
  • CT Scans: 
    • A CT scan can be helpful to check for complications of otitis media, such as infections in the mastoid bone, blood clots, or bone damage. 
    • It’s especially useful if only one ear is affected, as it helps rule out masses in the nasopharynx or eustachian tube.
  • MRI Scans: 
    • MRI is useful for identifying soft tissue masses that may be contributing to fluid buildup in the middle ear. 
    • MRI can also show how far a mass has spread, especially if it involves the brain. When combined with CT scans, MRI can give a clearer picture of both the soft tissue and bone structure.
  • Tympanometry: 
    • This test measures how well the ear responds to sound and is one of the most helpful tools for diagnosing otitis media with effusion. 
  • Tympanocentesis: 
    • This involves using a small needle to drain fluid from the middle ear. 
    • It can be done in the doctor’s office, even for young children if necessary.
    • Tympanocentesis is both a treatment and a diagnostic tool.
  • Myringotomy: 
    • This procedure is the best way to confirm the presence of fluid in the middle ear. 
    • It involves making a small incision in the eardrum to remove fluid and offers better exposure than tympanocentesis.

Treatment Options

Medications such as antibiotics, steroids, antihistamines, decongestants, and mucolytics have been used to treat OME. However, experts now recommend against these treatments because of concerns about side effects, cost, and a lack of proof that they work in the long term.

Surgery is currently the most effective treatment for OME that doesn’t go away on its own. Common surgical options include:

  • Myringotomy: A small cut is made in the eardrum to drain fluid, sometimes with the insertion of a tube to keep the ear open.
  • Adenoidectomy: Removal of the adenoids to help improve ear drainage.
  • Tonsillectomy: This is not generally helpful as a primary treatment for OME.

Ways to Reduce the Risk of Otitis Media with Effusion (OME)

You can help lower the risk of OME by making these changes:

  • Keep your child away from secondhand smoke.
  • Breastfeed if possible, as it can help protect against infections.
  • Avoid feeding your baby (either by breast or bottle) while they are lying flat.
  • Limit exposure to large groups of children, especially in daycare centers.
  • Keep your child away from other children who are sick.
  • Minimize exposure to known allergens that can trigger ear problems.

Chronic Otitis Media with Effusion (Glue Ear) in Children

In most cases, glue ear resolves within three months. However, some children may experience recurrent episodes, requiring ongoing monitoring.

If the fluid persists for more than three months and is affecting your child’s hearing or development, ear tubes may be recommended to drain the fluid and prevent further complications.

Glue ear typically causes temporary hearing loss, which resolves once the fluid drains. However, recurrent or untreated cases can lead to complications, including more permanent hearing issues.


- Keep your child away from secondhand smoke.
- Breastfeed if possible, as it can help protect against infections.
- Avoid feeding your baby (either by breast or bottle) while they are lying flat.
- Limit exposure to large groups of children, especially in daycare centers.
- Keep your child away from other children who are sick.
- Minimize exposure to known allergens that can trigger ear problems.

If your child is frequently asking for things to be repeated, appears less responsive, or shows signs of speech delays, they may have hearing issues related to glue ear.

Contact Us

If you are concerned that your child may have glue ear, Gertrude’s Children’s Hospital is here to provide expert care and guidance. Our pediatric ENT specialists will work with you to ensure the best treatment for your child’s hearing and overall health.

Contact us today to learn more about our Chronic Otitis Media with Effusion (Glue Ear) in Children treatment options.

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