Ep. 33: How to Treat and Prevent Glue Ear
Glue ear results from middle ear fluid that does not drain. I have already discussed how it happens; however, further discussion is needed to share how to treat and prevent glue ear.
Many physicians describe all episodes of middle ear fluid as glue ear, but I only use this term for the more advanced episodes where the fluid has become extremely thick. Ear fluid that does not drain in 3 months is the least likely fluid to drain without help.
I was shocked to read on the internet…and you know Dr. Google has lots of hidden goodies…that healthcare providers may monitor children for up to a year to determine if the symptoms change or get worse. Umm, no! If middle ear fluid fails to go away after 3 months, I highly recommend that you or your child get evaluated by an ENT physician.
Why does glue ear need to be treated?
Well, the obvious answer is to relieve the hearing loss and ear pain. Normal hearing is precious for all of us, but it is critical for young kids to learn and develop normally. Speech and language development may be severely delayed because of long term hearing loss.
I dedicated an entire post to some of the severe, permanent complications that can happen from untreated glue ear. As a brief summary, over time the eardrum stretches and becomes much thinner and the eardrum may wrap around the hearing bones. With constant pressure, the hearing bones can thin and become eroded. This damage requires more advanced surgery to repair.
Although the hearing loss may worsen, it does not typically lead to nerve damage. You need to remember that the ear has 3 parts: outer, middle and inner. The hearing nerve fibers are in the inner ear; therefore, fluid in the middle ear is not hurting the nerve. The sound is simply blocked from reaching the nerve.
Also, when the skin of the eardrum becomes trapped into some of the small areas of the middle ear, a cholesteatoma may develop. I discussed this problem in complications of ear infections but it also can occur from chronic retraction of the eardrum. This is another reason that improving the eustachian tube function is important.
Non-surgical glue ear treatments
The goal of treatment is pretty straight forward: the middle ear fluid needs to be removed. Depending upon the thickness of the fluid, this usually requires surgery with suction removal of the fluid. However, it can be possible to help fluid drain without surgery.
In the past, long term antibiotics were used’ however, even though this might have prevented new infections, it did not get rid of the fluid. Thankfully, physicians are much more aware of the need to avoid unnecessary antibiotics because of the risk of increasing the development of antibiotic-resistant bacteria and the desire to avoid medication side effects.
Sometimes a low-grade chronic ear infection is mistaken for glue ear, so an antibiotic trial might be reasonable. One trial only! Antibiotics only treat infection and will not drain the fluid collection.
Oral steroids were a fad a couple of decades ago (ask me how I know!). And by steroids, I mean corticosteroids used widely by medical professionals, not the “bad” anabolic steroids that athletes have abused. By aggressively attacking inflammation, steroids improve eustachian tube swelling and sometimes the middle ear fluid would drain. However, steroids have significant risks associated with them and only provided short term relief of eustachian tube swelling. Consequently, this treatment was never shown to be a good long term solution.
Afrin nose spray may be used short term to relieve eustachian tube swelling without the bigger risks of using steroids. This therapy is often useful to determine if chronic middle ear fluid is reversible or not. True glue ear will not drain out of the eustachian tube. This is also a great way to help nasal symptoms while beginning therapies like nasal salt water rinses and allergy treatments.
Surgical glue ear treatments
Not to be biased, but I believe the best immediate treatment for glue ear is in the form of surgery!
Some indications for surgery include:
- moderate hearing loss that is affecting both ears
- chronic changes to the eardrum
- unrelenting symptoms not controlled with other therapies
- some pre-existing health condition (see below)
Many children fall into a category which may not be considered severe enough for surgery; however, if they have other health conditions, surgery may be warranted at an earlier stage. Some examples include:
- a pre-existing hearing loss which is now compounded with glue ear hearing loss
- a suspected or diagnosed speech and language disorder, such as apraxia
- a developmental disorder such as autism
- a syndrome that is known to cause delays in speech, language and learning development, such as Down’s syndrome or cerebral palsy.
- a cleft palate which means eustachian tube dysfunction will last longer than normal
- blindness or severe vision problems
Some common types of surgical treatments which can be helpful to treat glue ear include
Ear tube placement
An ear tube is a very small tube that is placed into a small cut within the eardrum. The purpose of the tube is to drain away fluid in the middle ear and to help maintain the air pressure in the middle ear cavity.
This is the most common surgery to treat glue ear. Some people with chronic ear problems have many sets of ear tubes. I have previously shared what you should and should not expect from ear tubes. The bottom line, ear tubes are NEVER the final treatment. They simply buy time until the reason for the eustachian tube dysfunction can be treated.
In the operating room, while placing ear tubes, I sometimes have to rinse the middle ear with salt water in order to thin the mucus enough to remove the glue ear, which can be so thick that it takes several minutes to get it out. (Can I ever mention enough how wonderful that salt water is? So useful for the entire respiratory tract!)
An adenoidectomy is the surgical removal of the adenoid, which is is a soft mound of tissue at the back of the nose. I describe it to my patients as a “nose tonsil” because many people already understand about tonsil disease. Well, the same processes can happen to adenoid tissue: it can become too big or have recurrent infections.
Also, notice how I said adenoid and NOT adenoids. There are two tonsils on either side of the throat; however, there is only ONE adenoid, located directly behind the nose. The single adenoid can block the back of one or both nostrils which leads to nasal obstruction and mouth breathing.
But in terms of glue ear, an enlarged adenoid sits next to the eustachian tube and can easily block fluid from draining out of the middle ear. So in some cases, instead of simply inserting an ear tube, which has risks and complications of its own, some children benefit from removing the adenoid to unblock the eustachian tube.
The nose has many parts which I have outlined when describing the fabulous functions of the nose. The septum is the tissue that divides the nasal cavity in half and separates the left and right nostrils. During the course of life, including passing through the birth canal, the septum can be pushed into one of the nostrils.
When the nostrils are blocked by bone or cartilage, the resulting nasal obstruction can affect the eustachian tube. Usually this causes some ear infections or ear pain and pressure; however, it could be a contributor to glue ear formation.
If a severely deviated septum is present, surgery to straighten the inside of the nose may be helpful.
Turbinates are the tissues inside the nose that swell with colds and allergies. If chronic nasal congestion is present and does not respond to other management options, reducing the size of the turbinates may be needed.
In adults, this is a common procedure that can be done in the office by an ENT surgeon; however, kids require general anesthesia.
And rounding out the physical problems in the nose that may contribute to ongoing glue ear, chronic sinusitis is a known problem. Although most sinusitis complications are more severe, chronic ear infections and glue ear may need sinus surgery to be performed to allow for improvement of eustachian tube function.
Eustachian tube dilation
This is a relatively new procedure that holds the promise of some long term results. It is a procedure easily done in the office for adult and adolescent patients; however, young children need to have this procedure done under general anesthesia.
A recent study has shown that adults undergoing this procedure had ongoing symptom improvement up to one year. There has been much hesitancy about performing this procedure in kids because of concerns about possible long term changes to a developing eustachian tube. Nevertheless, there is a study with shows excellent results in a large group of children, starting around age 2.
I have not personally added this procedure to the care of my patients; however, there are slowly increasing numbers of surgeons who have. To better understand how eustachian tube dilation occurs, check out the following video.
Is there a way to prevent glue ear from recurring?
Once it has been treated, the main focus needs to be on ways to prevent glue ear from returning. If you are a person who makes thick mucus, steps must be taken to prevent this from recurring. The mucus comes from the upper respiratory mucosa and typically drains from the nose into the eustachian tube
- Drink more water
- Daily saline nasal washes
- Facial steamer
- Nasal steroid sprays
- Mucolytics (thins mucous)
- Avoid antihistamines (may thicken mucus)
Allergy diagnosis and long-term treatment
Because allergies are a huge cause of eustachian tube dysfunction, it is extremely important to have a formal evaluation. Many of my patients do not believe they have allergies until I complete testing and begin treatment. I have previously shared surprising allergy symptoms but besides medications listed above, these are treatments that are useful to prevent glue ear:
- Avoid allergies
Another method to prevent glue ear is also used by some people to help treat it! Children often do not tolerate this device, but many adults swear by it. At any rate, most manufacturers of these products do not recommend using it for kids under age 3. The benefit is that it is a non-surgical, drug-free treatment or prevention option for glue ear.
The technique is called autoinflation and works in a similar manner as when you try to pop your ears while on an airplane. Autoinflation is essentially a way of encouraging the eustachian tube to open. This can help drain the ear naturally through the eustachian tube, by forcing air from the back of the nose to the middle ear.
The balloon is blown up and while closing off the other nostril, the air is released to help open the eustachian tube. Some people find it useful to do this several times a day.
Check out this video to learn more about the technique.
Whew! Hopefully, my three-part blog series about glue ear has been helpful to you. If you have questions or need clarification, please feel free to reach out to me.
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