Good morning and TGIF! Welcome to today's Euan's ENT blogpost!
Today's topic is about ear fluid buildup. Why do our ears buildup with fluid and what can we do when it happens?
Let's take a look together shall we?
Q: How do our ears normally drain fluid?
Diagram showing the different parts of the ear, including the Eustachian tube which drains fluid away from the ear
In the normal situation, the mucus that is produced by the cells in the middle ear should drain down the Eustachian Tube (ET) into the nasopharynx, which is located at the back of your nose. Whenever you chew / swallow / yawn this triggers the opening of the ET.
Q: What causes fluid to build up in the ears?
1. Any blockage to the drainage pathway can cause an excessive build up of middle ear fluid
e.g. in children, the most common cause is enlarged adenoids which block the exit at the ET orifice.
Endoscopic image of enlarged adenoids which can cause blockage to fluid drainage
other causes may include:
In congenital conditions such as cleft palate / Down's syndrome, the incidence of GLUE EAR is much higher.
2. Disorders of muco-ciliary clearance may also cause mucus / fluid to build up. Conditions such as primary ciliary dyskinesia or Cystic Fibrosis have increased incidence of GLUE EAR
Q: What is "glue ear"?
Otoscopic Image of the eardrum with a buildup of fluid behind it
Glue ear is also called Otitis Media with effusion (especially in the USA); both refer to the condition whereby fluid / mucus builds up in the middle ear space and causes a conductive hearing loss.
Q: What are the symptoms of glue ear?
Signs and symptoms of glue ear can include:
problems hearing – children may want to have things repeated, talk loudly or have the television up loud.
some pressure or pain in the ear.
irritability or problems sleeping.
problems with balance.
See a GP if your child has hearing problems.
Your child may be struggling to hear if they often:
speak loudly
are difficult to understand
ask people to repeat what they say
ask for the TV or music to be turned up loud
struggle to hear people far away
become easily distracted when people are talking
seem tired and irritable because it's harder to listen
Q: How is glue ear different from getting water stuck in the ear?
Glue Ear or Otitis Media with Effusion (OM e) means a build-up of mucus/fluid in the middle ear space BEHIND the eardrum. This means you cannot remove the fluid using a cotton bud, unlike the situation when water enters your ear canal and remains trapped in the ear canal OUTSIDE or EXTERNAL to the ear drum.
for more info about water getting stuck in the ear canal, you can refer to my earlier BLOGPOST:
Q: What are the treatment options for glue ear?
1. Conservative management:
to try and promote natural drainage via the Eustachian Tube down to the nasopharynx
Treatment for glue ear from your GP:
Glue ear is not always treated. The GP will usually wait to see if the symptoms get better on their own.
This is because there's no effective medicine for glue ear, and it often clears up on its own within 3 months.
Your child may be monitored for up to a year in case their symptoms change or get worse.
The GP may suggest trying a treatment called autoinflation while waiting for symptoms to improve.
Autoinflation can help fluid in the ear to drain.
It's done by either:
blowing up a special balloon using 1 nostril at a time; these are called OTOVENT balloons
swallowing while holding the nostrils closed
As autoinflation has to be done several times a day, it's not usually recommended for children under 3 years old.
Sometimes, antibiotics may be prescribed if glue ear causes an ear infection.
2. Surgical Management :
Myringotomy:
an incision is made in the eardrum after injecting local anesthetic that allows the fluid to drain out the ear. The hole made will heal by itself over time.
Endoscopic image of the eardrum after an incision is made allowing fluid to drain
Grommet Tube insertion:
A grommet is a small tube that's placed in your child's ear during surgery. It drains fluid away and keeps the eardrum open.
The grommet should fall out naturally within 6 to 12 months as your child's ear gets better and the hole in the eardrum closes naturally.
Endoscopic image of grommet inserted into the eardrum to drain fluid over time
If your child needs grommets, you might find these links useful:
Great Ormond Street Hospital (GOSH): treatment of glue ear with grommets
National Deaf Children's Society (NDCS): Harvey gets grommets
Hospital treatment for glue ear
Your child may be referred to a specialist in hospital if:
glue ear symptoms are affecting their learning and development
they already had severe hearing loss before glue ear
they have Down's syndrome or a cleft lip and palate, as glue ear is less likely to get better by itself
The 2 main treatments are temporary hearing aids or grommets (small tubes implanted in the ear).
The hearing aids serve to overcome the conductive hearing loss due to the glue ear.
Occasionally, surgery may be recommended to remove some glands at the back of the nose (adenoids). This is known as an adenoidectomy.
The ENT specialist can help you decide on the best treatment option.
I hope you found this interesting. TGIF! Thanks for reading!
Until next time,
Dr Euan
If you would like to seek treatment for otitis media with effusion, or other ENT-related conditions, please feel free to Contact Us at Euan's ENT Surgery & Clinic to make an appointment.
If you are keen to delve deeper, here are some references for you to check out!
REFERENCES:
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