Treating glue ear

If you notice a change in your child’s hearing, your GP can examine your child’s ears to see if there are any signs of infection or blockages. Your GP may monitor your child to see if this clears up by itself or may immediately refer your child to the audiology or ear, nose and throat (ENT) department at your local hospital for a hearing test.

After being referred to the hospital, if your child is diagnosed with glue ear and their hearing is affected, the audiology or ENT department will monitor the glue ear for 3 months. This is called ‘watchful waiting’. At the end of this period, your child’s hearing will be retested to see if the glue ear has cleared up. In 50 to 90% of cases, glue ear clears up within 3 months.

Find out about how you can support your child during the watchful waiting period, or while waiting for an appointment at the hospital.

If there’s no improvement, your child might be offered hearing aids or a surgical intervention, such as grommets.

Hearing aids are devices designed to make sounds louder. They can be used on a temporary basis for children whose hearing is affected by glue ear, especially if the glue ear is persistent or comes back regularly.

Good quality, digital hearing aids are available free of charge for all children on the NHS. Your child may also be offered a bone conduction hearing device.

Find out more about hearing aids.

The Otovent nasal balloon (also known as nasal balloon autoinflation) is a non-surgical, drug-free treatment option for glue ear. Autoinflation is a method of encouraging the eustachian tube to open. This can help drain the ear naturally through the eustachian tube, by forcing air from the back of the throat to the middle ear.

The Otovent is suitable for children from 3 years old. It’s made up of a balloon and a nosepiece. This treatment involves fitting the balloon to the nosepiece, putting the nosepiece against one nostril and keeping the other nostril and mouth closed. The child then blows into the balloon through their nose until it’s the size of a grapefruit. The nosepiece is removed and the steps repeated with the other nostril.

The Otovent may be helpful for some older children during the watchful waiting period or while waiting for grommet surgery.

Otovent kits can be prescribed by a GP or ENT doctor while you’re waiting for treatment. They can also be bought over the counter relatively cheaply.

Find out more about Otovent.

Grommets are tiny plastic tubes that are put in the eardrum during a short operation. The operation is usually done as a day case under general anaesthetic. The surgeon will drain the fluid in the middle ear and then insert a grommet into the eardrum. The grommets allow air to circulate in the middle ear, keep the pressure equal on either side of the eardrum, and stop fluid from building up.

The surgeon may talk to you about removing your child’s adenoids at the same time. Adenoids are glands at the end of the eustachian tubes that sometimes become infected and swollen and block the end of the tubes.

You might notice a discharge coming out of your child’s ear for a couple of days after the operation. This discharge is sometimes blood-stained. It should stop after a couple of days. If the discharge is still there after a few days, ask your GP for advice and antibiotic drops. Any prolonged discharge from the ear should be assessed by your ear, nose and throat (ENT) doctor.

After your child has had the surgery, there’s usually one routine appointment a few weeks later. This will involve a check to see that the grommets are in place and a hearing test to check that your child’s hearing is back within the normal range. After that, further appointments may only be made if you report any problems.

Grommets usually stay in for around 6 to 12 months, until the eardrum has healed. Grommets usually fall out by themselves. Sometimes, the fluid comes back and another grommet operation may be considered. Your ENT doctor should always discuss any risks of a second operation with you.

Swimming and bathing with grommets

Your ENT doctor will recommend keeping your child’s ears dry for the first two to four weeks following the surgery. After this, most children with grommets do not need to take any special precautions and can swim and bathe as usual with grommets in.

Some children may be at particular risk of infection if water enters the ear. If your child at higher risk of infection, your ENT doctor may suggest some of the following precautions.

• Try to avoid your child diving or jumping into the water as this increases the outside pressure and forces water through the grommet into the middle ear.
• Use earplugs and neoprene headbands, like the [link] Ear Band-It. Some audiology services can provide custom fit swim plugs.
• Encourage your child to wear a swimming cap.
• Avoid your child swimming in lakes or non-chlorinated pools. The water in these places usually has a high bacteria count so infection is more likely to occur.
• Be careful when washing your child’s hair. Soapy water can slip more easily through the grommet into the middle ear and can cause infection. With your child sitting upright in the bath, wash their hair first before washing the body. Tilt their head back and rinse with clean water, then apply a shower cap. This way your child can play in the bath without getting dirty, soapy water in their ears.

In 2023, the National Institute for Health and Clinical Excellence (NICE) published guidance about glue ear for the NHS in England and Wales. Having studied all the research evidence available, they made recommendations on the use of various treatments for glue ear based on which treatments effectively treated the greatest number of children. NICE currently recommends grommets or hearing aids as effective treatments for glue ear.

As of 2023, NICE does not recommend using:

• steroids
• antihistamines
• decongestants
• antibiotics
• homeopathy
• cranial osteopathy
• acupuncture
• massage
• probiotics
• changing the diet (for example, to reduce dairy)
• immunostimulants

There is very little or poor-quality evidence available for some of these treatments. The alternative or complementary health sector doesn’t usually produce the type of scientific evidence reviewed by NICE.

Read the NICE guidelines on identifying and managing glue ear in children.