Glue ear

Glue ear is a condition where excess mucous (glue) accumulates in the ear instead of air. This fluid interrupts the passage of sound into the ear leading to a conductive hearing loss.

Causes

Children are at more risk of developing glue ear because the eustachian tube does not function as well as in adults and can be easily obstructed. If your child is allergic to pets or dust then the risk of developing glue ear is higher because inflammation caused by the allergic reaction results in swelling and blockade of the eustachian tube.

Enlarged or infected adenoids may also block the eustachian tube. Adenoid glands are situated at the back of the nose and throat that fight against germs and bacteria which invade the body.

Symptoms

Inattention, frustration, hearing loss, delayed speech and language development.

Diagnosis and treatment

Dr Williams primarily examines your child’s ear by an instrument called an otoscope. In addition, an audiogram (to check if your child can hear) and tympanogram (to check the compliance and movement of the eardrum) may be required.

Several options are available for the management of glue ear.

Watchful waiting for 3 months.

Surgical placement of ventilating middle ear tubes (grommets).

Surgery may also be performed to remove the adenoid gland if there is evidence of nasal obstruction at the time of the first grommet surgery, or if a second set of grommets is required.

Grommets

Grommet insertion is a surgical procedure in which a tiny ventilation pipe (grommet) is inserted into the eardrum to treat glue ear.

The exact cause of fluid build-up in the middle ear is unclear, but it may be due to improper functioning of the Eustachian tube.

The Eustachian tube is a narrow tube that connects the middle ear to the back of nose. The tube helps in maintaining the balance of air pressure between the middle and outer ear. Opening of the tube while swallowing, chewing or yawning allows inflow of air into the middle ear and outflow of fluid thereby balancing air pressure on each side of the eardrum. If the Eustachian tube fails to open properly or gets blocked due to respiratory tract infections or allergies, an air pressure imbalance is created on either side of the eardrum thereby disrupting its function. This imbalance causes the fluid to fill up the space of the middle ear thereby preventing its drainage. Grommets help in maintaining equal air pressure by enabling drainage of this fluid from the middle ear.

Procedure

The aim of the procedure is to effectively restore hearing in individuals who are suffering from hearing loss due to middle ear fluid.

Grommet insertion is a short duration procedure carried out under general anaesthesia. Dr Williams will make a small incision of about 2-3 mm in the eardrum and drain out the fluid from the middle ear with the help of suction. A grommet is then inserted into the eardrum which allows immediate entry of air into the middle ear to keep it ventilated.

Post-operative Care

Following the surgery, sound will be heard at a much higher level than before the surgery. This is normal and you will get used to this normal level of hearing in a few days.

• It is important to protect the ears from water while the grommets are in place. You may be advised to use cotton wool with Vaseline to plug the ear which prevents water entering into the ear
• You are allowed to swim as long as you have your doctor’s permission. Make sure to wear ear plugs while swimming
• Immediately consult your surgeon if you notice foul smelling ear discharge
• Your doctor may prescribe antibiotic drops to prevent ear infection.
• Avoid inserting sharp objects into the ear
• Pain medications may be prescribed to relieve pain

Risks and complications

Generally, grommet insertion is a safe procedure. But as with any surgery, grommet insertion involves certain risks and complications. They include:

• Ear infection and discharge
• Perforated (hole) eardrum
• Minor eardrum damage and scarring

Grommets will allow entry of air into the middle ear for several months until it is naturally pushed out of the eardrum. Grommets will fall out after a period of 6 to 12 months which is usually enough time to resolve glue ear completely. However, if the fluid returns, or the problem of glue ear persists even after the grommet has fallen out, repeat grommet insertions may be required until the problem of glue ear is completely treated.

Tonsillitis in Children

Tonsillitis is the inflammation of the tonsils which are lymphoid tissue located at the back of the throat. The main function of the tonsils is to fight against bacteria, virus, or other germs that enter through the mouth or nose.

Most episodes of tonsillitis are caused by viruses. Only 30% are caused by bacteria.

Types of tonsillar infection

Acute tonsillitis

• Can present with sore throat, ear pain, fever, difficulty swallowing and tender glands in the neck

Recurrent tonsillitis

• May present with chronic sore throat, ear pain, bad breath, and persistent tender neck glands

Peritonsillar abscess

• Presents with severe throat pain, earache, fever, drooling, difficulty opening the mouth and change in voice (hot potato voice)

Medical Treatment

• The treatment of acute tonsillitis is largely supportive and focuses on maintaining adequate fluid intake and controlling pain and fever
• Corticosteroids may be administered to reduce swelling and pain
• Antibiotic therapy is recommended for acute tonsillitis. The treatment is usually with penicillin
• For those who cannot swallow fluids or medicines, admission to hospital is required for intravenous fluids and medicines

Surgical Treatment

The surgical removal of the tonsils is a safe and effective treatment for recurrent tonsillitis. It is not appropriate to operate on tonsils while they are infected unless an abscess has formed, or if the condition is chronic without remittance.