Glue ear is one of those conditions that is very common, often missed, and capable of causing real difficulty during a critical window for language development. A child who cannot hear clearly in the first years of life is working harder to make sense of speech, to follow instructions, and to participate in noisy environments like nursery or school.
Most cases resolve on their own. But persistent glue ear affecting both ears is a different situation from a brief episode after a cold, and it deserves proper assessment and monitoring rather than indefinite watchful waiting when a child's development is at stake.
Healthbooq (healthbooq.com) covers children's ear and hearing health through the early years.
What Glue Ear Is
Glue ear is the common name for otitis media with effusion (OME). The middle ear, which sits behind the eardrum, normally contains air. When the Eustachian tube (which connects the middle ear to the back of the nose) fails to ventilate the space properly, fluid accumulates. This fluid is typically thick and viscous, which is why it is called "glue" ear. It muffles sound transmission across the ossicles (the tiny bones of the middle ear) and reduces hearing.
Glue ear is extremely common. Around 80 per cent of children will have at least one episode by the time they start school. It is most prevalent between ages two and five. Boys are slightly more affected than girls. It is more common in winter and in children who attend group childcare settings, probably because of increased exposure to upper respiratory infections.
Risk factors for persistent or recurrent glue ear include: cleft palate (which affects Eustachian tube function), Down's syndrome, passive smoke exposure, and a family history of the condition.
How It Affects Children
The hearing loss from glue ear is typically mild to moderate and fluctuating, which makes it particularly hard for parents and teachers to detect. The child hears well on good days and poorly on bad days. They may appear inattentive or to be ignoring instructions. They may speak more loudly than expected or have particular difficulty in noisy environments.
In young children with significant or long-standing glue ear, speech and language development can be affected. The child may not be building vocabulary at the expected rate or may have difficulty discriminating similar sounds. In school-age children, it can affect reading and literacy acquisition.
A child who frequently asks for repetition, watches speakers' faces intently, or seems to mishear should have their hearing assessed rather than being assumed to have a behavioural or attention problem.
Diagnosis
Glue ear is usually diagnosed at a GP appointment, often prompted by a parent noticing recurrent ear infections, hearing concerns, or a history of repeated upper respiratory infections.
The GP can examine the eardrum with an otoscope: a healthy eardrum is translucent and pearly-grey, while a drum with fluid behind it may appear dull, amber-coloured, or have visible fluid levels. Tympanometry, which measures the movement of the eardrum in response to air pressure changes, is the most reliable simple test: a flat trace (type B) indicates fluid. Pure tone audiometry (a hearing test) gives the most detailed picture of hearing thresholds.
Most children with glue ear are referred to audiology or ENT after a period of watchful waiting.
Watchful Waiting
NICE guidance (CG60, updated) recommends a period of watchful waiting of at least three months for children with glue ear before intervention is considered, because most cases resolve spontaneously within this period. This three-month window should be measured from the time hearing loss was confirmed, not from when the problem is first thought to have begun.
During watchful waiting, the following can help: avoiding passive smoke exposure, managing allergic rhinitis if present, and ensuring good classroom positioning (near the front, away from background noise).
Antibiotics do not help with glue ear and are not recommended. Decongestants and antihistamines have no evidence of benefit and are not recommended.
Grommets
A grommet (tympanostomy tube, or ventilation tube) is a tiny plastic tube inserted through the eardrum under general anaesthetic. The procedure takes around ten minutes. The tube allows air to enter the middle ear directly, bypassing the dysfunctional Eustachian tube and restoring normal pressure and hearing almost immediately.
Grommets are considered for children who have had bilateral glue ear with documented hearing loss for three months or more, and where the hearing loss is affecting speech and language development, educational progress, quality of life, or behaviour. They are also indicated earlier for children with cleft palate or Down's syndrome, who are unlikely to experience spontaneous resolution.
The Cochrane review of grommets for glue ear (2010, updated 2015) found that grommets produce a mean improvement in hearing of approximately 12 decibels in the first six months. The benefit is real and clinically significant for children with moderate hearing loss. By 12 to 18 months, the hearing difference between children who had grommets and those who did not tends to narrow, because the glue ear often resolves spontaneously in the control group too.
Grommets stay in place for an average of six to twelve months before falling out on their own. Most children do not need repeat insertion, but around 25 to 30 per cent will require a second set. Adenoidectomy (removal of the adenoids) is sometimes performed at the same time; there is some evidence this reduces the need for repeat grommets.
After grommet insertion, most ENT surgeons advise protecting the ears from water, though the evidence on how much swimming and bathing restrictions improve outcomes is modest. Custom ear plugs are sometimes recommended for swimming.
Hearing Aids
For children where grommets are not indicated, or where surgery is not acceptable, hearing aids are an alternative that can bridge the period of hearing difficulty. They are available through NHS audiology services.
Key Takeaways
Glue ear (otitis media with effusion) is the most common cause of hearing loss in childhood. It occurs when thick fluid accumulates in the middle ear, impairing the transmission of sound. Most cases resolve spontaneously within three months. Children with persistent glue ear affecting both ears for three months or more, especially where speech, language, or learning is affected, may be referred for grommets, which are small ventilation tubes inserted into the eardrum under general anaesthetic. The Cochrane evidence shows grommets produce a modest but real short-term hearing improvement. The decision to proceed should weigh the natural resolution rate against the impact of hearing loss on the individual child.
