Glue Ear

What Is Glue Ear?

Glue ear, known medically as otitis media with effusion (OME), is a condition in which thick, sticky fluid accumulates in the middle ear space behind the eardrum. Unlike acute otitis media — an active ear infection that causes pain, fever, and inflammation — glue ear involves a non-infected build-up of fluid that can persist for weeks or months. The fluid dampens the movement of the eardrum and the tiny bones (ossicles) of the middle ear, reducing the transmission of sound and causing conductive hearing loss.

Glue ear is the most common cause of hearing loss in children in the United Kingdom. According to NICE (National Institute for Health and Care Excellence), approximately 80% of children will experience at least one episode of glue ear by the age of ten, with peak incidence between the ages of two and five. While the majority of episodes resolve on their own within three months, a significant minority of children develop persistent or recurrent glue ear that requires medical intervention. It is also one of the most common reasons for referral to paediatric ENT (ear, nose, and throat) services in the NHS.

Although glue ear is primarily a childhood condition, it can also occur in adults, where it warrants more thorough investigation to rule out underlying causes. Understanding what glue ear is, how it is diagnosed, and the treatment options available is essential for parents, carers, and anyone affected by this common condition.

The Anatomy Behind Glue Ear

To understand how glue ear develops, it helps to know how the middle ear works. The middle ear is a small, air-filled cavity located between the eardrum (tympanic membrane) and the inner ear. It contains three tiny bones — the malleus, incus, and stapes — collectively known as the ossicles. These bones form a chain that amplifies sound vibrations from the eardrum and transmits them to the fluid-filled cochlea in the inner ear, where they are converted into electrical signals sent to the brain.

The middle ear is connected to the back of the nose and throat by the Eustachian tube (also called the pharyngotympanic tube). This narrow passage serves two critical functions: it equalises air pressure on both sides of the eardrum (the "popping" sensation you feel when swallowing during a flight), and it drains mucus and fluid away from the middle ear space. In healthy adults, the Eustachian tube opens briefly each time you swallow or yawn, allowing fresh air in and keeping the middle ear dry.

In young children, however, the Eustachian tube is shorter, narrower, and more horizontal than in adults. This anatomical immaturity makes it far more susceptible to blockage and Eustachian tube dysfunction. When the tube becomes swollen or blocked — commonly due to upper respiratory infections (colds), allergies, or enlarged adenoids — air can no longer enter the middle ear. The resulting negative pressure draws fluid from the surrounding tissues into the middle ear space. Over time, this fluid can become thick, viscous, and glue-like, hence the everyday name. The fluid prevents the eardrum and ossicles from vibrating freely, and sound transmission is reduced, resulting in hearing loss.

How Common Is Glue Ear?

Glue ear is remarkably common in early childhood. Research cited by NICE indicates that around one in five children will have glue ear at any given point during the preschool and early school years. The condition peaks between ages two and five, coinciding with the period when children are most susceptible to upper respiratory infections and when the Eustachian tube is at its most immature.

Data from the National Deaf Children's Society (NDCS) shows that glue ear accounts for the vast majority of childhood hearing loss cases in the UK. Most episodes are bilateral (affecting both ears), which tends to cause more noticeable hearing difficulty than single-sided involvement. The RNID (Royal National Institute for Deaf People) notes that while many cases resolve spontaneously, approximately one in three children who develop glue ear will experience recurrent episodes, and around 5-10% will have fluid that persists for a year or longer.

Certain factors increase the likelihood of developing glue ear, including:

• Attending nursery or childcare settings — increased exposure to respiratory infections
• Having older siblings — greater exposure to viruses in the household
• Passive exposure to cigarette smoke — a well-documented risk factor
• Bottle feeding while lying flat — associated with increased risk in infants
• A family history of glue ear — there is a recognised genetic predisposition
• Down syndrome or cleft palate — these conditions are associated with Eustachian tube abnormalities

Symptoms and Signs

Glue Ear in Children

The hearing loss caused by glue ear is usually mild to moderate, typically in the range of 20-40 decibels (dB). To put this in perspective, a 30 dB hearing loss means that normal conversational speech — which is typically around 60 dB — sounds as quiet as a whisper. For a young child in a busy, noisy classroom, this level of hearing loss can make it extremely difficult to follow what the teacher is saying.

Because glue ear develops gradually and is usually painless, children often do not complain about it directly. Instead, parents, carers, and teachers may notice behavioural changes that are actually caused by the child's reduced hearing. Common signs include:

• Not responding when called, or appearing to ignore instructions — often the first sign noticed at home
• Asking for things to be repeated frequently, or saying "what?" and "huh?"
• Turning up the volume on the television, tablet, or other devices
• Delayed speech and language development — difficulty learning new words, unclear pronunciation, or speaking more loudly than peers
• Inattentiveness or poor concentration at school — a child who cannot hear clearly may appear distracted or disengaged
• Behavioural changes — frustration, withdrawal, clinginess, or acting out, sometimes leading to the child being unfairly labelled as "naughty" or "difficult"
• Preferring to sit close to the teacher or the television
• Difficulty with reading and phonics — hearing is fundamental to learning the sounds that make up language
• Balance difficulties — less common, but some children with glue ear experience mild unsteadiness

If you notice any of these signs in your child, it is important to seek assessment promptly. The children's hearing development guide provides more detail on the milestones to watch for, and the signs of hearing loss guide covers the warning signs across all ages.

Glue Ear in Adults

Although far less common, adults can develop glue ear too. In adults, the symptoms typically include a persistent sensation of fullness or blockage in the ear, muffled hearing, and sometimes mild discomfort or a crackling sensation when swallowing. Adult-onset glue ear should always be investigated, as the underlying causes may differ from those in children. Common adult causes include Eustachian tube dysfunction, chronic sinusitis, allergies, and changes in air pressure (such as after flying). In rare cases — particularly when the effusion is unilateral (one-sided) and persistent — it is important to rule out nasopharyngeal pathology, including tumours of the nasopharynx, which can obstruct the Eustachian tube opening. For this reason, adults with unexplained unilateral glue ear are typically referred for ENT assessment, and may undergo nasopharyngoscopy as part of their workup.

How Is Glue Ear Diagnosed?

Glue ear is diagnosed through a combination of clinical examination and simple, painless tests. If you take your child to the GP with concerns about their hearing, the doctor will usually start with otoscopy — looking into the ear canal with a handheld instrument called an otoscope. In glue ear, the eardrum often appears dull, retracted, or amber-coloured, rather than the normal pearly grey. Air bubbles or a visible fluid level may sometimes be seen behind the eardrum.

The key diagnostic test is tympanometry, which measures how the eardrum responds to changes in air pressure. The test involves placing a small soft-tipped probe in the ear canal and takes only a few seconds. In a healthy ear, the eardrum moves freely and produces a peaked trace (Type A). In glue ear, the fluid behind the eardrum prevents it from moving, producing a characteristic flat trace known as a Type B tympanogram. This is one of the most reliable indicators of middle ear effusion.

A hearing test (audiometry) is also performed to determine the degree of hearing loss. In young children, this may take the form of a children's hearing test using visual reinforcement audiometry or play audiometry, depending on the child's age. Otoacoustic emissions (OAE) testing may also be used to confirm that the inner ear (cochlea) is functioning normally and that the hearing loss is conductive rather than sensorineural.

Together, these tests allow the audiologist or ENT specialist to confirm the diagnosis, measure the severity of hearing loss, and guide treatment decisions.

Treatment: The NICE-Recommended Pathway

Treatment for glue ear in the UK follows a clear, evidence-based pathway set out by NICE. The approach is stepped, beginning with the least invasive options and escalating only when necessary.

Step 1: Watchful Waiting (Active Monitoring)

Because the majority of glue ear episodes resolve spontaneously, NICE recommends an initial period of active monitoring for three months from the date the effusion is first documented. During this time, no specific medical treatment is required, but parents and teachers should be aware of the hearing difficulty and make simple accommodations — such as speaking face-to-face, reducing background noise, and ensuring the child can see the speaker clearly. Follow-up tympanometry and hearing tests are arranged to track whether the fluid is clearing.

NICE explicitly advises against the use of antibiotics, antihistamines, decongestants, or intranasal steroids for glue ear, as evidence shows these medications do not provide lasting benefit and may cause unnecessary side effects.

Step 2: Autoinflation (Otovent)

For children aged three and over who can cooperate, autoinflation may be offered. This involves using a special balloon device called an Otovent, which the child inflates by blowing through one nostril while holding the other closed. The action helps to open the Eustachian tube and equalise pressure in the middle ear. Studies have shown that autoinflation can improve symptoms and tympanometry results, particularly when used regularly over several weeks. It is non-invasive, inexpensive, and can be done at home, making it a useful option for families keen to avoid surgery.

Step 3: Hearing Aids as a Non-Surgical Option

If glue ear persists beyond three months and is causing significant hearing difficulty, hearing aids may be offered as an alternative to surgery. A well-fitted hearing aid can amplify sound sufficiently to overcome the conductive hearing loss caused by the fluid, supporting the child's speech, language, and learning while waiting for the condition to resolve naturally. The NHS hearing services provide hearing aids free of charge for children. This option is particularly suitable for children who have medical reasons that make general anaesthesia risky, or for families who prefer a non-surgical approach. Our guide to choosing hearing aids explains what to expect from the fitting process.

Step 4: Grommets (Ventilation Tubes)

When glue ear persists for three months or longer and is associated with a hearing level of 25-30 dB or worse in the better ear, NICE recommends considering surgical insertion of grommets (also known as ventilation tubes or tympanostomy tubes). Grommets are tiny plastic or metal tubes, typically only a few millimetres across, that are inserted into a small incision in the eardrum under general anaesthetic.

The procedure — called a myringotomy with grommet insertion — typically takes around 10-15 minutes and is performed as a day-case operation, meaning the child goes home the same day. It is one of the most commonly performed childhood operations in the UK, with NHS data showing that tens of thousands of sets of grommets are inserted each year.

How grommets work: the tube sits in the eardrum and creates a small channel that allows air to enter the middle ear directly, bypassing the blocked Eustachian tube. This ventilation prevents fluid from re-accumulating and allows any existing fluid to drain. The improvement in hearing is usually immediate — many parents report a dramatic difference in their child's hearing and behaviour within days of the operation.

Grommets are designed to be temporary. They typically fall out on their own after 6-12 months as the eardrum naturally heals and pushes the tube out. By this time, the child's Eustachian tube has often matured enough to function properly. In some children, however, glue ear recurs after the grommets fall out, and a second set may be considered.

After grommet insertion, most ENT departments advise keeping the ears dry during bathing and swimming, though guidance on this varies — some surgeons are more relaxed about water exposure than others. Follow-up appointments are usually arranged at 6-12 weeks post-operatively, and then periodically until the grommets have extruded and hearing has been confirmed as normal.

Potential complications of grommets are uncommon but include persistent ear discharge (otorrhoea), early extrusion, blockage of the tube, and — rarely — a small perforation of the eardrum that does not heal after the grommet falls out (occurring in approximately 1-2% of cases).

Adenoidectomy

In some children, particularly those requiring a second set of grommets or those with significantly enlarged adenoids, an adenoidectomy (surgical removal of the adenoids) may be performed at the same time as grommet insertion. The adenoids are pads of lymphoid tissue located at the back of the nasal cavity, near the opening of the Eustachian tubes. When enlarged — which is common in young children, especially those with frequent infections — they can physically block the Eustachian tube opening and act as a reservoir for bacteria. NICE recommends considering adjuvant adenoidectomy for children aged three years and over who are having repeat grommet surgery, as evidence suggests it reduces the likelihood of further episodes of glue ear.

Impact on Child Development

The hearing loss caused by glue ear, even when mild, can have a significant impact on a child's development if it occurs during the critical years of speech and language acquisition. The National Deaf Children's Society (NDCS) emphasises that consistent access to sound is essential for children learning to talk, read, and interact socially. When hearing is intermittent or reduced — as is typical with glue ear, which often fluctuates — children may miss key speech sounds, struggle to develop vocabulary at the expected rate, and find it harder to learn phonics and early reading skills.

Research published in the British Medical Journal and cited by NICE has explored the long-term developmental outcomes of children with persistent glue ear. While most children catch up once their hearing improves, those with prolonged or severe episodes may benefit from additional support. The children's hearing development guide outlines the key stages to monitor.

Schools play a vital role in supporting children with glue ear. Practical measures that can make a real difference include:

• Preferential seating — placing the child near the front of the classroom, close to the teacher
• Face-to-face communication — ensuring the teacher faces the child when speaking, so lip-reading and facial expressions can support comprehension
• Reducing background noise — closing windows and doors, using soft furnishings to dampen echoes
• Radio aids (FM systems) — a wireless microphone worn by the teacher transmits directly to a receiver worn by the child, dramatically improving the signal-to-noise ratio
• Visual aids and written instructions — supplementing verbal information with pictures, diagrams, and written notes
• Additional one-to-one support — particularly for phonics, reading, and language activities
• Pastoral support — acknowledging the child's frustration and building confidence

Parents can request an assessment of their child's needs through the school's Special Educational Needs Coordinator (SENCO). The NDCS provides excellent free resources for families and teachers supporting children with temporary hearing loss caused by glue ear.

Prevention and Reducing Risk Factors

While it is not always possible to prevent glue ear — particularly given how common upper respiratory infections are in young children — there are steps that can reduce the risk or frequency of episodes:

• Avoid exposure to cigarette smoke. Passive smoking is one of the strongest modifiable risk factors for glue ear. Children living in households where adults smoke are significantly more likely to develop recurrent middle ear problems. The NHS strongly advises keeping children in a smoke-free environment.
• Breastfeeding. Research published by NICE and the NHS indicates that breastfeeding for at least the first six months is associated with a reduced incidence of middle ear infections and glue ear, likely due to the immune-protective factors in breast milk and the mechanics of breastfeeding positioning.
• Keeping vaccinations up to date. The pneumococcal conjugate vaccine (PCV) and the annual flu vaccine both help reduce the respiratory infections that commonly precede glue ear. The NHS childhood immunisation schedule includes both of these.
• Good hygiene practices. Regular handwashing and teaching children to cover coughs and sneezes can reduce the spread of the respiratory viruses that trigger ear infections and Eustachian tube inflammation.
• Upright bottle feeding. For bottle-fed infants, holding the baby in a semi-upright position during feeds may reduce the risk of milk entering the Eustachian tube.
• Managing allergies. If a child has known allergies that cause nasal congestion, effective management of these allergies may help keep the Eustachian tubes functioning more efficiently.

When to Seek Help

If you suspect that your child may have glue ear — or if a teacher or health visitor has raised concerns about your child's hearing, speech, or attention — it is important to see your GP promptly. Early identification means earlier support, and even if the condition resolves on its own, having a baseline hearing assessment provides valuable information.

Adults who experience persistent muffled hearing, a sensation of fullness in one or both ears, or a change in hearing that does not improve after a cold should also seek assessment. As noted above, unilateral symptoms in adults should be investigated to exclude other causes.

Your GP can examine the ears, arrange tympanometry and a hearing test, and refer to ENT or audiology services if needed. You can also book a hearing assessment directly with high-street audiologists such as Boots Hearingcare, Specsavers Audiology, or Hidden Hearing. Many offer free hearing tests and can provide tympanometry on the same visit. Use our appointment finder to locate an audiologist near you, or read our guide on how often you should have a hearing test for more advice on routine screening.