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What Are the Indications for Surgery for Glue Ear?
Am Fam Physician. 2004 Mar 15;69(6):1540.
Otitis media with effusion, or “glue ear,” is a common condition in children. An evidence-based review by Browning concludes that surgery (usually the insertion of grommets or ventilation tubes) is beneficial only in a small minority of children who meet well-defined clinical criteria.
Glue ear has two peaks of increased incidence during childhood, each related to increased social mixing of children and consequent exposure to upper respiratory infections. The first peak, around one to two years of age, is associated with beginning day care, and the second peak, around five years of age, coincides with the start of school.
In children younger than three years, glue ear usually results from acute otitis media, is unilateral twice as often as bilateral, and takes up to 10 weeks to resolve. In older children, about one half of cases are unilateral, resolution takes about two months, and about 7 percent of cases recur. Resolution rates at four, eight, and 12 months are 52, 78, and 91 percent, respectively, but cases diagnosed during the winter tend to last longer. Resolution takes longer if the child has frequent upper respiratory infections, siblings with glue ear, or a mother who smokes tobacco. Each of these factors doubles the rate of persistence, but only 4 percent of children between three and one half to five years of age who are referred for surgical assessment have all three factors.
About one half of children with persistent bilateral glue ear have detectable hearing impairment, but this impairment generally is mild and is not associated with long-term speech, language, learning, or behavior disorders. In children younger than three years, clinical trials have not shown benefit in speech and language outcomes from the insertion of ventilation tubes. In children older than three years, clinical trials indicate that the benefit of surgery is limited to those with bilateral glue ear that persists after watchful waiting for at least 12 weeks and a bilateral hearing impairment of 20 decibels or more.
In a British trial of more than 4,000 children referred for surgical assessment of glue ear, only a small minority were assessed as meeting the criteria to benefit from surgery. Children who underwent surgery had an immediate and noticeable improvement in hearing, but after three months, tubes may be blocked or be extruded, or re-accumulation of fluid can immobilize the ossicular, chain leading to conductive deafness. By one year, the benefit over the nonsurgically treated children is not apparent, because many of the children treated conservatively experience spontaneous resolution.
The author stresses that surgery may benefit individual children who are carefully selected for potential benefit to hearing and related issues, such as speech, learning, and behavior. Despite parental concerns, the majority of children with glue ear are unlikely to benefit from surgery or medication. He stresses the importance of monitoring children with audiometry and tympanometry to identify those with delayed resolution of glue ear, and the critical role played by parents and others in maintaining the development of communication skills in children. Regardless of the presence of glue ear, the development of speech and language depends on intra-family communication, especially between mother and child.
Browning G. Evidence-based advice for glue ear. The Practitioner. August 2003;247:626–35.
Copyright © 2004 by the American Academy of Family Physicians.
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