Glue Ear and why Hearing Tests are so important.

Glue ear is essentially fluid behind the eardrum. This fluid builds up as a result of recurring ear infections . The tube that should drain the fluid from the middle ear, the Eustachian tube, can become inflamed and blocked. Over time, this fluid may become thick (hence the name – glue) and cause discomfort, and can also affect the child’s hearing. Imagine hearing everything with water in your ears! That is what it sounds like for a child with glue ear.

While ear infections are easy to diagnose, glue ear can be more difficult. Sound waves travel through the ear by vibrating the eardrum and then these vibrations are transferred to three tiny bones in the middle ear and then to the inner ear where the vibrations are interpreted as sound. If the middle ear contains fluid rather than air, the movement of the sound waves through this area to the inner ear is affected.

Very often, if glue ear is a persistent problem, the child’s speech and hearing may be affected and this in turn can lead to behavioural issues as they become frustrated. Audiology tests are important as they will both confirm the presence of fluid behind the ear drum and test the child’s hearing.

Audiology testing will include a tympanometry test, which measures how well the eardrum can move. If there is fluid in the middle ear the eardrum will not work properly. A hearing test will also be done to check if the glue ear is affecting your child’s hearing and if so, by how much.

Look out for the following if you think your child may have glue ear:

No reply when called

TV turned up loud

Complains of ear pain or discomfort

Speech is delayed

Lack of concentration

Balance issues or clumsiness

In school going children they may begin to fall behind at school

Treatment

Paediatric osteopathy can help drain this fluid from the ears. It is a wonderful first option treatment as it is so gentle. As winter approaches, we always begin to see more children with ear infections as a result of the usual coughs and colds picked up at that time of year. Many parents also bring their children back for check-ups to keep them healthy over the winter.

Another helpful idea is an Otovent auto-inflation device. This is suitable for children who are old enough to blow their nose. The aim of the device is to inflate the balloon with the nose. The balloons are included in the kit and are specially pressurised. This action helps to open the Eustachian tubes allowing the fluid associated with glue ear to safely drain away.

Sometimes grommets may need to be inserted by an ENT doctor to assist the drainage. This is a very minor surgical procedure done under a general anaesthetic where a small incision is made in the ear drum and little plastic tubes are inserted to allow fluid to drain. Children who have grommets inserted should avoid getting water in their ears. Precautions should be taken when swimming and at bath-time.

A great product for swimming is the Ear Band-It Ultra headband which was invented by an Ear Nose and Throat (ENT) physician. This headband will hold earplugs in place while the child is swimming. Occasionally the grommets can fall out. If this happens, the eardrum heals naturally itself.

How paediatric osteopathy can help ear infections and glue ear

As a paediatric osteopath, I treat children with recurrent ear infections and glue ear frequently. Firstly, I examine the available movement in their temporal bones; these are the bones at the side of the skull in which the ear is located. I observe the position of the temporal bones compared to each other and compared to the occipital bone at the back of the skull.

A flat head in baby may affect the movement of the ear bones and the adjacent bones of the skull. Babies who have had a forceps delivery are more likely to have increased tension in the temporal bones due to the pressure applied during delivery.

By reducing the tension in the temporal bones, the function of the Eustachian tube is improved and this in turn helps fluid to drain from the middle ear. I also examine upper rib cage movement and the tension in the muscles that connect the ribs to the ear bone surfaces, as many ear infections originate in the upper respiratory tract as a result of coughs and colds.

Successful treatment must also include the doctor, as ear infections may continue to occur occasionally. The fluid in the middle ear is thick and mucousy and can take time to drain. However, over time, the ear infections become less frequent and the glue ear begins to resolve.

If you would like more information about ear infections, glue ear and hearing tests listen to Episode 4 of The Happy Baby Podcast

Sadie’s story

Sadie was a great baby. She had a little reflux but that seemed to settle down after a few months. A week after her first birthday she got an ear infection and needed antibiotics. She recovered quickly but after three weeks she got another one. This was the start of her getting ear infections every six weeks or so. Her sleep got worse too and she had been a great sleeper.

After her sixth antibiotic I brought her to see Frank. He told me that she had some fluid behind her eardrum and that this was very likely causing the repeated infections. He treated her three times over a six week period and after the second treatment, she started sleeping through the night again. She was so much happier and thankfully has not had another ear infection since.

Mark’s story

Mum brought Mark to see me when he was three years old. She said that Mark had got his first ear infection at eighteen months old and to date, was just finishing his ninth antibiotic. She was down to visit the doctor every three to four weeks.

I asked Mum to tell me Mark’s story. He had reflux from six weeks to six months but when he went on solids it eased. He was a very poor sleeper and only started sleeping through the night at two years. He had persistent congestion, waxy ears, runny nose and a night-time cough. He had a tough teething process, lots of dribbling, chewing, red cheeks and wakeful nights and would fall a lot when learning to walk. He had up to ten to twelve ear infections at this stage, some of them viral, others bacterial with a discharge from his ear.

The key here was the recurrent nature of the ear infections. I asked Mum about any family history of ear infections. Dad had grommets as a child and a first cousin also had to have grommets inserted. In my experience there is often a previous family history in children with recurring ear infections and glue ear. It’s worth asking the question at case history.

I treated Mark at the clinic over a period of six weeks, three treatments in total. I focused treatment on the respiratory system, activation of ribcage, lengthening of musculature of the neck, deepening the breathing and improve the ear surface motion to help Eustachian tube drainage.

I advised Mum to undertake a decongestion home plan. This involved giving Mark probiotics to strengthen his immune system response, using a Salin salt pump at night to decongest and dry up mucous, and decreasing diary intake and substitute with other fortified diary sources. I suggested a visit to the doctor to check ear integrity.

I reviewed Mark after six weeks. He was ear infection-free, less congested and healthy. If the plan hadn’t worked and Mark’s response was poor, I would have asked his Mum to contact his doctor to get a referral to an Ear Nose and Throat consultant because in my opinion a family history of ear infections can be significant as some children may inherit smaller Eustachian tubes than others.

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