Chronic glue ear: Are ear tubes an appropriate treatment?
Treating chronic glue ear using ear tubes can temporarily improve hearing somewhat because they clear out the middle ear. Hearing also improves after about six months in children who don't have treatment with ear tubes.
Children often get colds, and it's not uncommon for their ears to be affected too. Infections in the nose or throat area can easily spread to the middle ear, particularly in young children. Directly behind the eardrum there is a space in the middle ear called the tympanic cavity. This small space is usually filled with air which sound waves travel through to reach the inner ear. If a middle ear infection causes the mucous membranes to swell up and secrete fluid, the tympanic cavity fills up with the fluid. This is called otitis media with effusion or "glue ear." Sometimes the canal leading from the middle ear to the throat (the Eustachian tube) becomes blocked too.
If the fluid can't escape, it builds up behind the eardrum and the child can't hear properly. Glue ear usually goes away after a few days or weeks, If it doesn't, the resulting poor hearing can delay speech and language development in children.
When a child has persistent glue ear, doctors usually recommend waiting a few months to see if it clears up on its own. They can check the child's ears regularly in the meantime. If the glue ear does not clear up, a minor surgical procedure called paracentesis may be considered. This involves puncturing the eardrum. Then the fluid can drain out, or it is removed using suction.
If fluid still keeps on building up in the child’s ear and he or she can't hear properly, ear tubes are often recommended. These thin plastic or metal tubes are placed in the middle ear through the cut (incision) in the eardrum so that the middle ear is better ventilated. They aim to help glue ear get better, improve hearing and prevent delayed speech and language development. Ear tubes are normally inserted while the child is under general anesthetic, and they usually fall out on their own after about 6 to 18 months. The incision in the eardrum closes on its own too.
Research on ear tubes
Because there is some disagreement about the benefit of ear tubes, researchers from the Cochrane Collaboration – an international research network – looked for randomized controlled trials in this area. In this kind of study the participants are randomly divided into two or more treatment groups. At the end of the study, the groups are compared to see the effects of the different treatments. When looking at the treatment of chronic glue ear in children, this means that one group of children is given ear tubes while the other group either has no treatment or they only have their eardrum punctured (paracentesis).
Ear tubes improve hearing in the short term
The researchers found ten studies involving more than 1,700 children with chronic glue ear. After analyzing these studies, they concluded that the use of ear tubes can somewhat improve hearing within the first nine months. After one year there were no longer any differences between the groups. The children could hear equally well, regardless of whether they had received ear tubes or not. No influence on speech and language development was found.
The ear tubes also had side effects: They led to increased mucous discharge from the ear, particularly in children under the age of three. About one third of the children with ear tubes had scarring of the eardrum, which may slightly affect their hearing.
Waiting is usually a good strategy
Because ear tubes have only limited effectiveness, it's often a good idea to not have surgery after just three months, but to wait under close medical supervision. Ear tubes may still be an option if the glue ear has not gone away on its own within six months. This watchful waiting treatment approach is probably just as effective as early surgery over the long term.
It can't be ruled out that some children will benefit more than others from treatment with ear tubes. Like any operation, though, the insertion of ear tubes is associated with certain risks, such as damage to the eardrum or scarring. More research is needed to be more confident about when the short-term advantages of ear tubes are worth the risks associated with surgery.
Browning GG, Rovers MM, Williamson I, Lous J, Burton MJ. Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev 2010; (10): CD001801.
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