Glue ear is also known as otitis media with effusion. It involves fluid accumulation in the middle ear without signs of acute infection. It causes conductive hearing loss.
Glue ear can occur following acute otitis media (infection in the middle ear). It can also occur when drainage from the middle ear through the Eustachian tube is impaired, leading to fluid buildup in the ear.
Presentation
The main presenting feature is hearing loss. In young children, this may present as mishearing, communication difficulties, social withdrawal, changes in behaviour, or impaired speech development.
Otoscopy can show a dull tympanic membrane with air bubbles or a visible fluid level. However, it may appear normal.
Investigations
Children with suspected glue ear should be referred for:
- Audiometry (hearing testing)
- Tympanometry
Tympanometry assesses tympanic membrane movement. In glue ear, movement is reduced because fluid in the middle ear makes the membrane less mobile.
Management
Glue ear is usually treated conservatively. Most cases resolve spontaneously within 3 months. Children with co-morbidities affecting the ear’s structure, such as Down’s syndrome or cleft palate, are more likely to require early intervention. Hearing aids may be helpful in children with hearing loss.
Grommets are tiny tubes inserted into the tympanic membrane by an ENT surgeon. They ventilate the middle ear and equalise pressure, allowing the effusion to resolve. They are usually inserted under general anaesthetic as a day case procedure. The procedure is relatively safe with few complications. Grommets usually fall out within a year. Some children require repeat grommet insertion if glue ear persists or recurs.
Adenoidectomy (removal of part or all of the adenoids) may be considered in some cases to improve Eustachian tube drainage and reduce the risk of glue ear recurrence.
Last updated June 2026
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