When I worked in Jersey, I ran a joint ENT clinic with the Consultant ENT Surgeon. It was one of my favourite parts of the week, not only because the Consultant was one of the loveliest gentlemen on this planet, but also because I got a really in depth knowledge of all sorts of ENT conditions. Between us, the Consultant and I could usually 'diagnose' a condition within 5 seconds of seeing a child walk through the door. There are certain tell-tail signs.
The first tell-tail sign is permanent train tracks of snot down their noses, even when it's summer. You know the ones! If their nose is blocked up that much for that long, you can guarantee that their Eustacian Tubes are blocked up too. But first , we should probably start with...
What is Glue Ear? Or Otitis Media
Glue ear refers to a build up of fluid in the middle ear section (behind the ear drum) because the Eustacian tube is blocked. For ears to work properly, they need the middle ear to be kept full of air. That air comes from the Eustacian tube which is a tiny tube leading from the back of your throat to your middle ear. You can imagine that little people have even tinier Eustacian tubes and it doens't take much to block them. Children with Cleft Palate and Downs Syndrome are also more susceptible because of the structure of their tubes. When air doesn't get through, then fluid builds up and the wee bones in the middles ear can't function very well.
Are some children more likely to develop Otitis Media?
There are some risk factors, but it's not properly understood why some children do and some children don't get Glue Ear
The most important risks include:
A family history of Otitis Media
Exposure to tobacco smoke ("passive smoking")
Exposure to other children in child care/creche/pre-school, not because it is catching but because the viruses that contribute towards the 'snotty noses' are.
An older sibling in childcare/creches/pre-school/early primary school
Interestingly enough, there is no clear evidence, supporting allergy as a causal factor in the development of otitis media.
There is some limited evidence linking bottle-feeding to early development of acute otitis media. This may be because of the immune protective effect of antibodies passed through breast milk, which inhibit the formation of bacteria. The position of feeding has also been suggested to contribute. You can read the evidence for yourself here.
How do you know if a child has got Glue Ear?
If any of your children are showing these characteristics, it might be worth suggesting to their parents that they get checked out by the GP or refer themselves for an audiology assessment.
- speak more loudly or quietly than usual
- are difficult to understand, especially if they don't say their /f/ or /s/ sound as these are higher in frequency and don't get picked up by a child with glue ear. They might say "bi" for fish or "dundine" for sunshine.
- Find it hard to locate where an instruction is coming from, if they are not looking at the speaker
- ask people to repeat what they say. The age old "wha?" question!
- ask for TV or music to be turned up loud
- struggle to hear people far away or just ignore you!
- become easily distracted when people are talking
- seem tired and irritable because it's harder to listen
- Parents might report the kids cry when they lie down and instantly stop when they are upright again.
Actually, they may feel irritable because it's an uncomfortable feeling not being able to equalise the pressure in your ears, as you'll know if you've ever experienced this sensation after flying. It might not necessarily hurt, but it is a pain in the arse. (Incidently, you know when you pinch your nose and blow to equalise the pressure? That's you forcing air down the Eustacian tube.
What can be done about it?
Doctors generally like to adopt a 'wait and see' approach with glue ear because it is transient and it is possible that a child will grow out of it. Sometimes glue ear can be silent and doesn't affect the child at all. Other times, it can make a parent/carer/child's day living hell. Generally speaking, if the child has had glue ear for more than 3 months, they may be referred to a specialist for hearing tests. But parents can self-refer for hearing and if there is any suggestion that the child's speech is being affected, then I'd strongly encourage them to get their hearing checked out.
There's no effective medicine for glue ear, and it often clears up on its own within 3 months. Antibiotics don't help because it's not an ear infection (although it can be associated with or cause an ear infection.)
When the wait and see treatment doesn't apply:
- If the symptoms are affecting their learning and development
- If they already had severe hearing loss before glue ear
- If they have Down's syndrome or a cleft lip and palate, as glue ear is less likely to get better by itself
Of course if the child has a stinky yellow discharge coming out of their ear, then this is an ear infection and may suggest a perforated ear drum. Some people call this "nature's grommet." I call it youchy.
The two main treatments are temporary hearing aids or grommets. Grommets are small, temporary tubes that are placed in your child's ear during surgery. They are not to drain the fluid out, but to let the air in, so they can air the middle ear. The operation is really quick and painless and in adults wouldn't even warrant a general anaesthetic - kids are just too wiggly to keep still for 5 minutes!
In rare cases, surgery may be recommended to remove some glands at the back of the nose (adenoids). This is known as an adenoidectomy. You'll know if a child is adenoidal if they are permanent mouth-breathers, dribble lots, snore when sleeping and are really noisy breathers. If this is the case, then the large adenoids can block the Eustacian tube and also cause sleep apnoea.
Grommets should fall out naturally within 6 to 12 months as the child's ear recovers. For more info, check out this info from GOSH.
There are a few cautions with grommets, such as swimming and bathing and there's really good info on the National Deaf Children's Society Website
So, obviously snotty kids are pretty much the norm in an early learning and childcare setting. But if they are still snotty in the summer, and they are pretty difficult to understand, then you might want t oask their parents how they've been at home, in terms of behaviour, sleep and listening.