Well, that sounds a little gunky. Glue ear, also known as otitis media with effusion or secretory otitis media, is a middle ear condition that affects about 80% of kids under ten years of age at least once during their single-digit years, with peak occurrences at 2 and 5 years old. While children are more prone to glue ear, adults can develop it, too.

What Causes Glue Ear?
And no, it’s not kids pouring glue into each other’s ears although this would probably result in similar symptoms. Glue ear involves a blockage of the Eustachian tubes that connect the middle ear to the throat, resulting in inhibition of normal drainage of fluid from the ear. An accumulation of fluid within the middle ear behind the ear drum leads to this fluid becoming thickened and sticky, much like glue.

Although glue ear itself is not considered an infection, it can arise from middle ear infections (also called otitis media) but can also just occur in the absence of any infection. Other causes of glue ear include:

  • A still-developing Eustachian tube, which is why glue ear is more common in little children with their little ears
  • Inflammation of the adenoids, which may transmit bacteria to the Eustachian tubes; or large adenoids, which can obstruct the tubes
  • Upper respiratory tract infections such as colds, or allergies, which cause congestion and swelling of the throat, nose, and Eustachian tubes
  • Developmental anomalies of the head and facial anatomical structures, such as cleft palate or Down syndrome

Glue ear occurs most commonly during fall and winter as these months often bring on more upper respiratory tract infections. Boys tend to be more affected than girls.

Exposure to secondhand cigarette smoke has been shown to significantly increase the risk of developing glue ear, possibly because the passive inhalation of tobacco smoke increases the risk of upper respiratory irritation and infection. Bottle-feeding the baby while lying on its back, the child attending daycare (around other germ-ridden kids), the absence of breastfeeding, and a tendency for allergies or colds are also risk factors for otitis media and glue ear.

Symptoms of Glue Ear
Glue ear in children may often go underdiagnosed as many kids don’t exhibit obvious symptoms. For others, the only symptom may be some degree of hearing loss as the build-up of fluid behind the ear drum prevents this membrane from vibrating and transmitting sound through to the inner ear, crucial steps of the hearing process.

Because of difficulties with hearing, young children with prolonged cases of glue ear may experience a delay in speech development and a general decline in performance at school as they find it difficult to participate in class or hear the teacher. This can also manifest as poor attention and irritability (but anyone with a young kid will know these symptoms are not unique to otitis media with effusion). A child with glue ear may also have a tendency to tug at his or her ears or demonstrate poor balance. Some parents report their child doesn’t sleep well during these periods and if the child is old enough he or she may report an earache (if the child is particularly precocious he or she may even report otalgia). Adults with glue ear may experience tinnitus and the sensation of a foreign object in the ear canal.

Glue ear is easily diagnosed by visualizing the ear drum with a tool called an otoscope. An ENT specialist, pediatrician, or general physician should be able to perform this, and will look for changes to the ear drum membrane that indicate fluid accumulation. Further tests may also be indicated, which may require referral to a specialist, such as an ENT doctor or audiologist. Tympanometry is a test to observe how well the ear drum (the tympanic membrane) is able to move back and forth; fluid build-up from glue ear prevents the membrane from moving. Age-appropriate hearing tests can also be useful and are even available for infants and toddlers unable to perform a traditional hearing test.

Treatment of Glue Ear
Most cases of glue ear self-resolve within 4 to 6 weeks without intervention and simply require monitoring and lots of repeating yourself when the child can’t hear you properly. If there is an accompanying upper respiratory tract infection then antibiotics may be prescribed but these medications are not used to treat the glue ear directly. Antihistamine, steroid, and decongestant medications are unfortunately of no help in this condition either. While waiting for the glue ear to resolve, it may be helpful to advise the teacher that the child has some trouble hearing so the poor thing doesn’t accumulate too many classroom demerit points for not following instructions.

If the gluey fluid persists for more than 3 months and is causing a significant impact on the child’s speech development or classroom performance, more invasive treatment with an ENT surgeon may be required. Myringotomy is a surgical incision in the ear drum to allow the fluid to drain away and in glue ear cases is often also followed by the insertion of a little tube, known as grommets or tympanostomy tubes, to facilitate drainage of fluid and the passage of air through the middle ear. These tubes tend to fall out of their own accord within a year. If enlarged adenoids are contributing to the development of glue ear, they can be removed through a surgical procedure called adenoidectomy. For parents who prefer to avoid surgical intervention, hearing aids to help the child keep up with speech development and learning is a non-invasive form of treatment (though it may be difficult getting the child to wear them).

Very persistent otitis media with effusion or untreated cases can cause long-term changes to the ear drum and middle ear structures, resulting in permanent hearing loss.

There is no sure method of prevention of glue ear but the likelihood of it occurring, especially for children who suffer from repeated cases, can be reduced by addressing any risk factors, such as exposure to secondhand smoke and head position during bottle- or breast-feeding. Parents who are concerned about their child’s ear health and hearing ability (and are sure the kid isn’t just ignoring you), should see an appropriate doctor for evaluation.

Otitis media with effusion (“glue ear”). https://www.bmj.com/content/343/bmj.d3770.full
Ear infections and glue ear. https://www.rch.org.au/kidsinfo/fact_sheets/Ear_infections_and_glue_ear/
Glue ear. https://www.healthdirect.gov.au/glue-ear#:~:targetText=Glue%20ear%20is%20an%20ear,%2C%20speech%2C%20learning%20and%20behaviour.
Otitis media with effusion (OME). https://www.chop.edu/conditions-diseases/otitis-media-effusion-ome
Otitis media with effusion. https://www.ncbi.nlm.nih.gov/books/NBK538293/
How does second-hand passive smoke exposure increase the risk of otitis media (OM) in children? https://www.medscape.com/answers/994656-8298/how-does-second-hand-passive-smoke-exposure-increase-the-risk-of-otitis-media-om-in-children
Ear infections and glue ear. https://www.rch.org.au/kidsinfo/fact_sheets/Ear_infections_and_glue_ear/
Glue ear. https://www.kidshealth.org.nz/glue-ear