Clinical features of glue ear

The highest incidence of glue ear is between the ages 2 and 5.

The patient may present with a variety of symptoms:

• hearing impairment
  • may be the only symptom (often not identified in infants and young children) (1)
  • may present as mishearing, difficulty when communicating in a group, requesting to repeat things, listening to television or audio devices at excessively high sound levels (2,3)
  • significant hearing loss may be observed in OME which is bilateral and has lasted for more than one month (4)
• speech or language development delay
• behavioural problems
  • lack of concentration or attention
  • being withdrawn
  • ear rubbing, irritability or sleep disturbances in infants
• learning difficulties at school
• recurrent ear infections or mild intermittent ear pain, fullness or “popping”
• history of recurrent upper respiratory tract infection or frequent nasal obstruction
• less frequently - balance difficulties, unexplained clumsiness, tinnitus and intolerance of loud noises (2,3)
• via screening

Signs include:

• fluid in the middle ear
• dull appearance of tympanic membrane with radial vessels visible - dark blue or grey colour of the tympanic membrane
• the tympanic membrane is immobile
• there is retraction of the ear drum
• Rinne's test negative; Weber's test - sound heard loudest in the deafer ear.
• there may be a flat curve with impedance audiometry

Reference:

• (1) Scottish Intercollegiate Guidelines Network (SIGN) 2003. Diagnosis and management of childhood otitis media in primary care
• (2) National Institute for Health and Clinical Excellence (NICE) 2008.Surgical management of otitis media with effusion in children
• (3) Institute for Clinical Systems Improvements (ICSI) 2008. Health care guidelines: Diagnosis and treatment of otitis media in children
• (4) Simpson SA et al. Identification of children in the first four years of life for early treatment for otitis media with effusion. Cochrane Database Syst Rev. 2007;(1):CD004163.