Glue ear is a common childhood condition in which the middle ear becomes filled with fluid. The medical term for glue ear is otitis media with effusion.

It is estimated that one-in-five children around the age of two will be affected by glue ear at any given time. Glue ear is more common during winter.

The main symptom of glue ear is some hearing loss in one or both ears. This usually feels similar to what you experience when you put your fingers in your ears.

Signs that your child may be having problems hearing include them: 

• struggling to keep up with conversations
• becoming aggravated because they are trying harder to hear
• regularly turning up the volume on the TV. 

Read more about the symptoms of glue ear. Contact your GP if you have any concerns about your child’s hearing.

Treatment

Most cases of glue ear don't require treatment as the condition will go away by itself; usually within three months.

Treatment is normally only recommended when symptoms last longer than three months and the hearing loss is thought to be significant enough to interfere with a child’s language and speech development.

In these circumstances, glue ear can usually be treated using minor surgery, which involves placing small tubes, known as grommets, in the ear. Grommets can help drain fluid out of the middle ear.

Read more about treating glue ear.

What causes glue ear?

The middle ear is directly behind the eardrum. It is made up of three tiny lever-like bones that carry sound vibrations from the eardrum to the inner ear.

With glue ear, the build-up of fluid prevents the three tiny bones in the ear from moving freely, which means they can’t pass sound vibrations to the inner ear, affecting hearing.

Exactly what causes the build-up of fluid is unclear, though more than half of all cases develop after a previous ear infection.

Growing up in a household where adults smoke also increases the risk of children developing glue ear.

Glue ear is not caused by getting water in the ear after swimming and showering, or due to a build-up of ear wax.

Read more about the possible causes and risk factors for glue ear.

Complications

Complications of glue ear include ear infections and a minor and usually temporary delay in speech and language development.

Read more about the complications of glue ear.

The most common symptom of glue ear is hearing loss.

The symptoms of glue ear can affect only one ear (unilateral) or both ears (bilateral).

The degree of hearing loss experienced usually ranges from slight to mild to moderate.

Signs to look out for that your child might be struggling to hear:

• They may have difficulty understanding people who are far away or speak quietly.
• They may also appear unusually tired or irritable because they have to try harder to listen to things.
• They may have difficulty understanding people who are far away or speak quietly.
• They may have problems picking out conversations in places where there is a lot of background noise.
• They may also easily "tune out" of conversations when they are distracted.
• They may only be able to understand face-to-face conversations that take place at a short distance.
• They may also experience problems with communication, learning and social skills (however, in most cases, these problems will resolve once their hearing is restored to normal).

Less common symptoms

Less common symptoms of glue ear include:

• episodes of mild ear pain
• irritability
• problems sleeping
• balance problems
• appearing unusually clumsy
• delayed speech and language development (in younger children)

When to seek medical advice

It's important to contact your GP if you're concerned that your child may be having problems with their hearing.

While glue ear is usually the most common cause of hearing loss in children, further tests may be required to rule out other possible causes.

The exact cause (or causes) of glue ear is unknown, but it seems to be due to a problem with a part of the body called the Eustachian tube.

The Eustachian tube

The Eustachian tube is a thin tube that runs from your middle ear to the back of your nose.

The Eustachian tube has two main functions, which are explained below.

• It ventilates your middle ear, helping to maintain a normal air pressure within the middle ear. Sudden changes in air pressure can be painful and, in some cases, can damage the ears. Changes in air pressure are responsible for the popping sensation that many people experience on an aeroplane.
• It helps to drain away mucus and other debris from the ear. The middle ear can often become clogged with mucus due to inflammation, infection or, in some cases, an allergic reaction.

With glue ear, the Eustachian tube seems to lose the ability to drain away the mucus. The mucus builds up inside the ear, which leads to glue ear. The reasons for this loss of function are still unclear, but some suggestions include:

• changes in air pressure inside the ear that lead to a blockage in the Eustachian tube
• inflammation of the Eustachian tube due to infection or irritants, such as cigarette smoke, which causes the tube to narrow
• gastric fluids from the stomach that leak up through the throat and into the Eustachian tube
• genetic mutations (altered genes) – some children may be born with certain genetic mutations, so their Eustachian tube does not develop properly

Risk factors

While it is not known exactly what causes glue ear, several factors have been identified as potentially being linked to an increased risk of children developing the condition.

These include:

• living in a house where the parents smoke
• not being breastfed
• having a brother or sister who also developed glue ear
• having a large number of brothers and sisters (this may be due to a higher risk of infection when there are several children in the house)
• having a cleft palate (a cleft palate is a type of birth defect where a child has a split in the roof of your mouth)
• having allergic rhinitis (an allergic condition that causes cold-like symptoms such as having a runny nose and sneezing)
• having Down’s syndrome (a genetic disorder that causes learning difficulties and disrupts physical development)
• having cystic fibrosis (a genetic condition that causes the lungs to get clogged up with thick, sticky mucus)

Your GP will ask you about your child’s symptoms and whether you've noticed any changes in the pattern of their behaviour, such as changes in their speech or their interaction with others.

A diagnosis of glue ear can usually be confirmed using an instrument called an otoscope. An otoscope is a small, hand-held device that has a magnifying glass and a light source at the end. It is used to study the inside of the ear.

An otoscope can detect certain signs that usually indicate the presence of fluid inside the middle ear.

These include:

• the ear drum being pulled inwards
• the ear drum being an unusual colour
• the ear drum having a cloudy appearance, and bubbles and fluid are visible inside the ear

Further testing

Further testing is usually only required if your child’s symptoms persist for more than three months. The tests will usually be carried out your local ear, nose and throat (ENT) department.

Two tests that may be carried out include:

• an audiogram – to assess the extent of your child’s hearing loss
• tympanometry – to assess how much fluid is present in the middle ear

These tests are discussed in more detail below.

Audiogram

An audiogram hearing test is performed using a machine called an audiometer. The audiometer produces sounds of different volume and frequency. Your child will listen to the sounds through headphones. They will be asked to indicate when they can hear a sound and when they cannot.

This test will not cause your child any discomfort, and most children tend to find it interesting.

Your child's ability to hear the different sounds can be seen on a chart called an audiogram.

Tympanometry

Tympanometry is a test that measures how the ear drum reacts to changes in air pressure. A healthy ear drum should move easily if there is a change in air pressure. If your child’s ear drum moves sluggishly or not at all, it usually suggests that there is fluid in their ear drum.

During a tympanometry test, a probe will be place into your child’s ear. The probe changes the air pressure at regular intervals while transmitting a sound into the ear.

A measuring device is attached to the probe to record how the sound reflects back from the ear, and how changes in air pressure affect these measurements.

If less sound is reflected back when the air pressure inside the ear is high, it usually indicates that the ear drum is having problems moving due to fluid.

Read more about hearing tests in children.

For the first three months after glue ear has been diagnosed, a policy of "active observation" will usually be recommended. This means that your child will receive no immediate treatment, but their condition will be monitored by your GP.

This is because more than half of all cases of glue ear will resolve within three months and there is currently no medication that shortens the length of time the symptoms last.

A wide range of medications have been tested for treating the symptoms of glue ear, including:

• antihistamines 
• decongestants 
• steroid sprays 

Evidence suggests that they either have very limited or no effectiveness in shortening the duration of symptoms and can cause side effects.

Once three months have passed, your child will be tested again to see if they still have symptoms of glue ear.

When treatment is required

If testing reveals that your child still has fluid in their ear(s), it does not necessarily mean that they will automatically benefit from treatment. This is because 9 out of 10 cases of glue ear resolve within a year.

Treatment is usually only recommended if your child has:

• hearing loss causing significant problems with their learning, development and social skills
• persistent hearing loss lasting longer than three months
• very severe hearing loss
• Down’s syndrome or a cleft palate

Unlike in most other causes, glue ear is unlikely to get better by itself in children with either of these conditions. They also have pre-existing communications difficulties that could be made worse by persistent hearing loss.

In such a circumstance you will likely be referred to your local ear, nose and throat (ENT) department for further assessment and treatment.

The two main treatment options for glue ear are:

• hearing aids
• surgery

Hearing aids

Hearing aids are often recommended for children with Down's syndrome as the results of glue ear surgery for children with Down’s syndrome can be unpredictable.

Hearing aids can also be used when your child is unable to have surgery or you are unwilling for surgery to be carried out.

A hearing aid is an electronic device that consists of:

• a microphone
• an amplifier
• a loudspeaker
• a battery

Modern hearing aids are very small and discreet, and some can be worn inside the ear. The microphone picks up sound, which is made louder by the amplifier. Hearing aids are also fitted with devices that can distinguish between background noise, such as traffic, and foreground noise, such as conversation.

Read how hearing aids can be used to treat hearing impairment.

Surgery

Surgery for glue ear usually involves a procedure uisng a piece of equipment called a grommet (grommet insertion). A grommet is a very small tube that is inserted into your child's ear through a small cut in their eardrum.

A grommet will drain away fluid in the middle ear and help to maintain the air pressure in the middle ear cavity.

A grommet insertion is performed under general anaesthetic (where the patient is unconscious). It usually only takes about 15 minutes, so your child should be able to go home the same day.

During the first few days after surgery, your child may find that noises sound much louder than they are used to. This is normal and should pass as your child gets used to having a normal level of hearing.

A grommet will help to keep the eardrum open for several months. As the eardrum starts to heal, the grommet will slowly be pushed out of the eardrum and will eventually fall out. This process happens naturally and should not be painful.

Most grommets will fall out from 9 to 15 months after being inserted. Around one child in three will need further grommets.

Watch our animation showing how surgery is performed. 

Other treatments

There are several other treatments that are less commonly used to treat glue ear. These are described below.

Autoinflation

Autoinflation involves your child blowing up a special balloon using their nose. It helps to open up the Eustachian tube, which makes it easier for the tube to drain fluid from the middle ear.

Your child will need to do this regularly until all the fluid has drained away. Autoinflation can be a difficult procedure for young children to perform and is not always suitable.

If your child complains of pain during the process then you should no longer continue with this treatment.

Also, autoinflation should not be performed if your child has a cold, chest infection, throat infection or the flu.

Adenoidectomy

An adenoidectomy is the surgical removal of the adenoids.

The adenoids are soft mounds of tissue at the very back of the throat. They are part of the body’s immune system, which helps to fight infection. If your child’s adenoids are enlarged and swollen, they can sometimes block the Eustachian tube. Having them removed can help the Eustachian tube to work better.

An adenoidectomy is usually only suitable for children who are over three years old, and where there is evidence that their adenoids are contributing towards symptoms.

The procedure will be performed under general anaesthetic, and your child will usually able to go home the same day. An adenoidectomy is often performed at the same time as a grommet insertion.

Speech and language development

Children with glue ear may experience some delay in their speech and language development, particularly if their loss of hearing is prolonged and occurs before the age of three.

However, in most cases, the delay is only temporary, and children usually catch up with their peers once their hearing returns to normal.

One study looked at how children with an early history of glue ear performed at school. They found no significant differences when compared with other children of the same age.

Acute ear infection

An acute ear infection (otitis media) is a common complication of glue ear. It develops when bacteria infect the fluid inside the middle ear.

Symptoms of otitis media in children include:

• ear pain
• crying more than usual
• problems sleeping
• having a high temperature (fever) of 38C (100.4F) or above
• a discharge of fluid or pus from the ear

About four out of five cases of otitis media will pass within two to three days without the need for treatment.

Antibiotics can be used if symptoms are particularly severe.

Read more about the treatment of otitis media.

Tympanosclerosis

Tympanosclerosis is a term that describes the slight thickening of the eardrum tissue. It is a common complication in children with glue ear who were treated with grommets. It occurs in around one in four cases.

It is uncertain whether the thickening of the ear drum is due to the grommets, glue ear itself, or a combination of both.

A small amount of hearing loss is the most common symptom of tympanosclerosis. However, it is usually so mild that it is barely noticeable. When hearing loss is more severe, surgery may be required to reconstruct the ear drum.

Perforation

If glue ear is complicated by infection, there is a small risk that pus can form inside the middle ear. The pus can put pressure on the ear causing a hole (perforation) to develop in the ear drum.

A perforated ear drum is an uncommon complication of glue ear, occurring in an estimated 1 in 50 cases.

Having a perforated ear drum can lead to some loss of hearing. However, in most cases the ear drum heals by itself, within six to eight weeks.

In the remaining cases, a perforated ear drum can be treated using a type of minor surgery called myringoplasty where tissue is used to seal the hole in the ear drum.

Read more about the treatment of perforated eardrum.

As the cause of glue ear isn't fully understood, there is no known way of preventing the condition. However, there are steps that can be taken to reduce two of the known risk factors for children.

These steps include:

• your baby being breastfed
• making sure your child isn't raised in a smoky environment, and avoiding close contact with smokers (passive smoking)

Passive smoking

It is unclear why passive smoking increases the risks of developing glue ear. It may be that the smoke irritates the lining of the Eustachian tube, causing it to become inflamed.

Not smoking around your children also has many other important health benefits, including:

• reducing the risk of developing asthma
• reducing the risk of developing a chronic lung condition in adulthood
• reducing the risk of dying from sudden infant death syndrome (SIDS), which is also known as cot death

If you are a smoker, always try to smoke outside your house. Smoking in another room can still affect your children’s health because the smoke can easily travel from one room to another, and the toxic chemicals in tobacco smoke can stay in the air for several hours.

If you decide to stop smoking, your GP will be able to refer you to an NHS Stop Smoking Service, which will provide you with dedicated help and advice about the best ways to give up smoking. You can also call the NHS Smoking Helpline on 0800 022 4332 (7am to 11pm). The specially trained helpline staff will be able to offer you free expert advice and encouragement.

If you are committed to giving up smoking but you don't want to be referred to a stop-smoking service, your GP should be able to prescribe medical treatment to help with any withdrawal symptoms that you may experience after giving up.

For more information about giving up smoking, see treatment for quitting smoking and stop smoking.

Breastfeeding

As with passive smoking, it is uncertain why breastfeeding reduces the risk of glue ear. One theory is that breast milk contains proteins that help to reduce inflammation inside the Eustachian tube.

Read more about the benefits of breastfeeding.