Glue Ear

Accepted definition/diagnostic criteria Glue ear, medically termed otitis media with effusion (OME), is characterised by the accumulation of fluid within the middle ear without signs of acute infection. Diagnostic criteria focus on the presence of middle ear effusion, identified through symptoms such as hearing loss, a feeling of fullness in the ear, and lack of acute infection symptoms (e.g., fever or severe ear pain).

Epidemiology OME predominantly affects children, with a peak incidence between the ages of 2 and 5 years. It is estimated that 80% of children will experience at least one episode by the age of 10. The condition is more prevalent in the winter and spring months and is slightly more common in males than females. Risk factors include attendance at daycare facilities, exposure to tobacco smoke and a history of upper respiratory tract infections. More than half of cases in young children follow an episode of acute otitis media.

Diagnosis
Clinical features: Diagnosis primarily involves clinical assessment.

• Key symptoms include hearing difficulties, a history of middle ear infections, or balance problems.
• During otoscopy, the tympanic membrane may appear dull, lack mobility, or show an air-fluid level or bubbles behind the membrane.

Investigations: If the diagnosis is uncertain, tympanometry or audiometry may be used.

• Tympanometry assesses the mobility of the tympanic membrane and middle ear pressure, showing a flat trace (type B tympanogram) in OME.
• Audiometry can quantify the degree of hearing loss.
• Note that in adults with an unexplained unilateral middle ear effusion, nasopharyngeal carcinoma needs to be excluded.

Treatment Treatment aims to alleviate symptoms and resolve fluid accumulation. Management strategies depend on symptom severity, age, and the presence of risk factors for speech, language or learning problems.

• Watchful waiting: Many cases resolve spontaneously, so an initial period of watchful waiting is often recommended, typically for three months unless significant hearing loss or risk factors for developmental problems are present. Some children may be able to perform, and be helped by, auto-inflation.
• Medical treatments: There is limited evidence supporting the use of decongestants, antihistamines or corticosteroids. Antibiotics are not routinely recommended but may be considered in specific cases following specialist advice.
• Surgical treatments: Myringotomy with the insertion of ventilation tubes (grommets) may be considered for children with persistent OME and hearing loss, or where OME is causing significant symptoms (e.g., balance problems, poor school performance). Adenoidectomy may be considered in recurrent cases or when adenoidal hypertrophy is present.

Prognosis Most cases of glue ear resolve spontaneously within three months. Persistent OME may lead to hearing loss and potential speech or developmental delays. Long-term sequelae are rare but can include tympanic membrane retraction or chronic suppurative otitis media. Regular monitoring and appropriate intervention are key to ensuring a favourable outcome.