The national charity Defeating Deafness is urging parents and GPs to take action to ensure that children with glue ear obtain early treatment to restore their hearing. The charity has issued a five-point checklist to help identify vulnerable children as British parents and GPs brace themselves for the regular winter epidemic of glue ear among young children, and experts warn of unacceptable delays in treatment.

Defeating Deafness is calling for earlier referral to ear nose and throat specialists of those most likely to benefit from surgery in the light of new evidence that children with glue ear are at risk of behavioural and educational problems lasting well into their teens.

Glue ear, ‘otitis media with effusion’ (OME), is the biggest single cause of hearing loss in children. It is very common, affecting more than 20 per cent of two-year-olds and 15 per cent of five-year-olds in winter. Although the problem can set in as a complication of acute ear infections and other respiratory illnesses, it can also occur independently.

Surgical insertion of ‘grommets’ in the tympanic membrane is the only effective way of restoring hearing to children with persistent glue ear, which occurs when fluid collects in the middle ear space of one or both ears and cannot drain away.

But the procedure has been declining in popularity since the late 1980s in favour of a policy of ‘watchful waiting’, whereby children with glue ear are kept under review in the hope that their problems will resolve spontaneously - which does sometimes happen in the less severe cases.

Unpublished British research in three major population centres shows that GP referrals of children with glue ear to ENT specialists fell by more than half between 1994 and 1998. In a parallel trend, the quarterly rate of grommet insertions in England fell from 2.1 per thousand children in 1992 to less than one per thousand in 1999*.

Many specialists believe that this policy has now gone too far, with children waiting many months and even years for treatment. This has negative effects on their behaviour and schooling as well as their hearing and poses a risk of long-term damage to the ears.

‘Studies have shown that the presence of a significant hearing loss in young children affects behaviour, the acquisition of skills, and speech and language development,’ explains Professor Tony Wright, Director of the Institute of Laryngology and Otology at London’s Royal National Throat, Nose and Ear Hospital, and an adviser to Defeating Deafness.

‘The longer a child waits for surgery the longer these problems persist and the greater the risk of structural damage to the ear, which can lead to long-term deafness among other problems.’

These concerns have been thrown into sharp focus by the publication of new research showing that the effects of glue ear persist far beyond childhood.** Data from a large ongoing study of more than 1,000 children born in Dunedin, New Zealand in the early 1970s suggests that early glue ear affects behaviour, IQ and reading into the late teens.

By comparison with ‘normal’ children, those with a history of glue ear had lower IQ up to age 13, more hyperactive and inattentive behaviour up to 15 and reduced reading ability up to 18.

The authors of the study conclude that ‘early middle ear disease history appears to have a deleterious effect on reading ability, verbal IQ and behaviour problems, as reported by parents and teachers, including inattentive and hyperactive behaviour.. .the future challenge for health professionals and parents will be to identify persistent, long term cases of OME and to intervene in ways that evidence shows to be justified.’

One of those authors, Professor Mark Haggard, Director of the Medical Research Council’s Institute of Hearing Research and Chief Adviser to defeating Deafness, believes the correct intervention for established glue ear is surgery, particularly for children over the age of three-and-a-half, who have been clearly shown to benefit from grommets.

‘This concept of watchful waiting to stop children being routed too directly into surgery was a necessary step in its time,’ he says, ‘but the policy has now gone too far. There are no firm guidelines about when to stop watching and do something. If you watch too long, with the accumulation of delays which inevitably occur in a hard-pressed NHS, it means that many children just don’t get treatment and so have continuing problems and are disadvantaged by the time they come to school.’

Professor Wright believes that watchful waiting is, in any case, built into the NHS, since the system almost always ensures a 6-9 month wait before a child with glue ear gets to see an ENT specialist. ‘By that stage only a few of the children will get better spontaneously, so they should be operated on without further delay,’ he says. ‘Grommets are not magic — but they are the only effective treatment we have to restore hearing.’

Defeating Deafness is urging early referral to an ENT specialist for children with persisting hearing loss, especially if they***:

• Show related behaviour and communication problems

• Are prone to repeated ear infections

• Are exposed to smoking at home

• Attend — or have siblings attending — school, playgroup or nursery

• Have a family history of ear infections and glue ear.

As part of its campaign to raise awareness of glue ear this winter, Defeating Deafness has produced a revised version of its parent information leaflet, emphasising the need for early intervention in high-risk cases.

A copy of the revised leaflet on Glue Ear and other information/advice is available from Defeating Deafness Information Service. Please write marking your envelope ‘Glue Ear’ and enclosing a large SAE (with stamps worth 33p) to Defeating Deafness FREEPOST, London WC4 938,

* BMJ 200 1;323:1096-1097
**Arch Dis Child 2001;85:91-95
***J Health Serv Res Policy, vol 6 no 3 July 2001, 139-144

Troy, 7
Troy suffered constant ear infections and a blocked nose from infancy. He spoke in a very loud voice, exhibited aggressive behaviour and didn’t hear when he was called from another room. His mother first sought medical advice about his hearing when he was two, but the glue ear was sporadic and surgery was not recommended. At school he was slow to learn and had problems hearing stories read out to the class. He was finally seen again by an ENT specialist after his mother pushed for a referral last year — four years after his problems first became apparent. By this time he had significant hearing loss in both ears. He had grommets inserted earlier this year and his hearing is now normal. His mother was upset and annoyed that he had to wait so long.

Stephanie, 7
Stephanie is the youngest of four siblings, all of whom have had problems with their ears. Stephanie’s problems became apparent when she started primary school: she couldn’t hear what was being said in class and her teacher thought she was going deaf. Stephanie’s doctor confirmed a hearing loss but it took two years before she was referred for surgery, by which time she was falling behind at school. Her mother feels she had to wait too long. The difference in Stephanie’s hearing since the operation is really noticeable and she is now in the top group at school.

Matthew, 8
Matthew passed a hearing test for the first time in his life just before his eighth birthday. He was referred for speech therapy at 18 months because he wasn’t talking well and was then found to have glue ear. He had to wait for grommets until he was nearly five, but they didn’t work and he had to wait a further two years for a second operation. When he was six, and a long way behind with his school work, he was fitted with a hearing aid. Three months ago he had the second set of grommets inserted and his hearing is as good as it can be, although he still can’t hear a whisper. At eight years of age, his parents have been told that he has the educational level of a five-and-a-half year old and will probably never catch up with the other children in the class. He has persisting behaviour problems, which his mother attributes, at least in part, to frustration.