Glue ear – a silent disease in our children

Glue ear or Otitus Media with Effusion (OME) can easily go undetected in children, however the effect of persistent OME on a child’s development can be profound. This is because OME may not only result in short term problems with hearing and behaviour, but also has long term effects on the auditory system and language development.

OME is characterised by inflammation of the middle ear mucosa and presence of fluid in the middle ear space. In young children, the immaturity of the immune system and of the Eustachian tube function means that OME is more common in this population

How common is OME in children?

OME has highest prevalence in the colder months of the year and overall is attributed to be the most common cause of acquired conductive hearing loss in children. The NZ Vision and Hearing Screening Program uses tymanometry to detect abnormal middle ear function and reports a failure rate of 6% for 3 year olds.

A recent study of Pacific Islanders living in NZ reports the prevalence of OME in 2 year olds to be as high as 25%.

How is OME detected?

The trouble is that young children may not complain about having difficulty hearing or feeling blocked in their ears. It is often not until a health professional examines the ear that the dull bulging eardrum is detected. Parents and caregivers should look out for symptoms including: behavioral problems, not responding to instructions, fluctuating hearing, poor balance, clumsiness, poor speech development, frequent coughs and colds, runny nose, sniffing and mouth breathing.

What are the effects on children?

OME can cause a conductive hearing loss up to moderate levels (50dBHL) and often hearing will fluctuate. A bilateral moderate hearing loss makes listening to speech very difficult, whereas the impact of unilateral OME may not be so noticeable.

Children need good hearing not just to learn, but also to monitor and develop their own language skills. OME commonly occurs in pre-lingual children and a large hearing loss can interfere with their speech development process. Additionally, fluctuating hearing during this time has been attributed to problems with processing auditory information resulting in significant learning disabilities later on.

Additional complications of OME include cholesteotoma, erosion of the middle ear bones, tympanosclerosis and mastoid infections.

What are we doing about it?

Detection

The National Vision Hearing Screening Program currently targets 3-year-olds and new entrants for tympanometry screening. However because there is no convincing evidence that routine screening for OME is effective, the future plan is to screen hearing prior to school entrance. This change means that responsibility of detecting OME during the most intensive period of language development will primarily be their family doctor.

Prevention

The Ear Nurse Specialist service provides a mobile ear clinic to the community. By treating OME at earlier stages, the mobile service not only prevents long-term compounding effects of untreated middle ear disease but reduces waiting lists for the hospitals and increases awareness within the community.

Treatment

90% of children with OME will resolve asymptomatically within 3 months. When tympanometry results indicate poor middle ear function or OME is suspected, an audiogram should be performed to determine the effect on the child’s hearing. If the symptoms persist after 3 months of observation then intervention should be considered as spontaneous resolution is unlikely. There is equivocal opinion on use of antibiotics to treat the OME as the benefits may only be temporary. Grommet insertion results in resolution of the fluid by allowing ventilation into the middle ear space.

REFERENCES:

Paterson JE et al. Pacific Islands family study: The prevalence of chronic middle ear disease in 2 year old Pacific children living in New Zealand. International J Pediatric Otorhinolaryngology 2006. 70 1771-1778.
New Zealand Vision and Hearing Screening Report July 2004 - June 2005.National Audiology Centre.
Primary Care Management Guidelines: New Zealand Ministry of Health National guidelines. Otitis Media in Children 26 August 2004
11:33.29.

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