What is glue ear?

14 December 2018 FAQs 1171
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In brief, glue ear is a condition where thick fluid accumulates in the middle ear space.

It is thought that the middle ear lining starts to produce this liquid following an infection or series of infections. The main symptoms in glue ear are pain and hearing loss. Persistent glue ear may later on give rise to complications like eardrum retraction and middle ear infection called cholesteatoma if the fluid is not removed. Benefits of removing the fluid include a reduction in the frequency of ear infections and improvement in hearing.

Glue ear usually affects children, mainly between the ages of 2 and 6. It is also related to the presence of lumps of lymphoid tissue in the space behind the nose (post-nasal space), called adenoids. A diagram of the ear (see below) shows that a natural tube, designed to aerate the ear, runs between the middle ear cavity and the postnasal space. This is called the Eustachaian tube and also acts as a drain for fluid in the ear. If this tube does not function well, or if the fluid is too thick, fluid remains for long periods of time in the middle ear cavity. Only those patients whose effusion persists for longer than8-12 weeks are selected for surgery. Other patients with recurrent persistent middle ear infections may also need surgery.

Surgeons may help in this common condition by placing a plastic tube in the eardrum after draining the middle ear fluid. This tube is called a grommet and is shaped like a cotton-reel. It is only 1-2mm in size and allows air into the middle ear to help the middle ear lining dry up and return to normal

The Operation

This is carried out under general anaesthetic.

The insertion of grommets is frequently carried out in addition to removal of the adenoids. No incisions are made on the face and drainage of the middle ear is carried out through the ear canal. The surgeon would need to use an operating microscope to create a slit-like incision in the line of the eardrum fibres so as to minimize trauma. Fluid is removed by suction and a grommet inserted.

Adenoids are removed from the back of the nose through the mouth using a special curette.

The operation takes about 15-20 minutes.

After the operation children have a sore throat for about 24 hours but there is usually no pain in the ears. Hearing is restored immediately. These operations are carried out as day-cases, since recovery is quick.

Are there any complications?

Bleeding form the adenoid bed is very rare but may occasionally require special packing and an overnight stay.

Parents are often worried that grommets will cause scarring in the drum. Scarring of the drum may occur but hearing loss due to scarring is much less that hearing loss due to the glue ear itself

Postoperative infection may occur which causes a discharge of infected fluid from the ear but its incidence is much reduced by the one-time application of antibiotic ear drops at time of surgery.

How does the grommet drop out?

The grommets used are standard ‘Shah’ type grommets, which drop out between 1year and 2 years after surgery. The time grommets spend in the eardrum, however, varies from patient to patient. The grommet is actually pushed out by a pouch, which forms on the internal side of the eardrum. There is no postoperative restriction on activities (not even strenuous sports like gymnastics). Flying is very comfortable as there is instant equalization of pressure between external and middle ears.

Children are allowed to swim but are discouraged from ducking their head below the water. They are advised to wear earplugs in this case. Hairwashing may be carried out as normal but cottonwool with vaseline smeared on the outside, or earplugs are advisable at least in the first two weeks after operation. It is not possible to feel or disturb your grommets with your finger!

Patients may occasionally retain their grommet for a longer period of time. In this case (less than 5%) a perforation of the eardrum may occur.

In about 25% of patients glue reforms once the grommet drops out and reinsertion of the grommet is necessary once more to maintain satisfactory hearing.

Patients are usually seen one to two weeks postoperatively and then at intervals of six months.

 


 

Disclaimer: Patients are advised to discuss their medical condition and any indications for medical treatment or surgery with their general practitioner or the specialist who is delivering health care. This article is designed to help with frequently asked questions and does not take any responsibility for specific patients.

ÓMr. Adrian M Agius

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