I see children at the Spire Cambridge Lea Hospital, and the Nuffield Hospital, Cambridge.
After a cold or viral illness, a negative pressure can develop in the space behind the ear drum (middle ear). This negative pressure pulls fluid from the lining of the ear. The fluid is trapped and causes deafness. It is a bit like hearing through cotton wool. Most children develop glue ear at some point in the first 5 years of life, especially when they go to nursery and pick up coughs and cold. Occasionally, adults can develop glue ear. If an adult develops glue ear on one side only, we must consider the possibility of a cancer in the back of the nose blocking one Eustachian tube (nasopharyngeal carcinoma).
When your child comes to see me, I would ask about attendance at nursery, smoking in the household, sore throats, snoring and if your child stops breathing for more than 10 seconds at a time (OSA). I would examine the nose, throat, neck and ears. A normal ear drum should be glistening white. Glue ear makes the ear drums pink and dull. I would normally order a hearing test (audiogram) and pressure test (tympanogram)
The hearing test would give me an idea of the degree of hearing loss. The pressure test confirms the presence of glue ear (fluid). If glue ear is confirmed, I would repeat the test again in 3 months, as half the children, with glue ear will get better, spontaneously. Glue ear tends to be worse in the winter. During the summer, glue ear may resolve because there are less coughs and colds.
If a second hearing test confirms glue ear, I would suggest treatment. Non-surgical treatment includes the use of hearing aids. Surgical treatment is grommet insertion. Grommets are plastic tubes. You child comes into hospital and has a general anaesthetic (is fully asleep). I look into the ear with a microscope. I remove any wax and make a hole in the ear drum with a small knife. There are no cuts or bruises on the skin. I use a vacuum to remove the fluid from behind the ear drum. I put the grommet into the hole to keep it open. This relieves the negative pressure and allows any fluid build-up to be swept down the Eustachian tube into the back of the nose. The child is woken up and can go home the same day. The risks of surgery are pain, bleeding, infection, general anaesthetic, the grommet may fall out earlier than planned, or may not come out spontaneously, and require another operation to remove it after 2 years, persistent ear drum perforation after the grommet falls out, the glue ear can recur requiring more than one set of grommets, and there is a 20% risk of mortality if COVID positive during a general anaesthetic, so it important to do lateral flow tests in the lead up to surgery.
I would normally order a hearing test 6 weeks after the operation to check the hearing has improved. Traditionally, ENT surgeons have suggested keeping water out of the ears to reduce the chance of infection. This is particularly the case for soapy water which has lower surface tension and might pass through the hole in the grommet. You can use a cotton wool ball, smothered in vaseline, sitting in the outer ear to keep water out of the ear.
The grommets are designed to work themselves out of the ear drums after 6-9 months. The hope is that once they have fallen out, and the ear drum heals, the glue ear does not recur. I would normally keep an eye on the child in clinic until the grommets have fallen out and recheck the hearing to make sure the glue ear has not recurred.