Happy NY! In this second blog in a series about glue ear (OME) and childhood hearing loss, I will consider treatment options for persistent OME with hearing loss.

Otitis media with effusion (OME) may resolve naturally and therefore in the UK a period of 3 months of ‘active monitoring’ following diagnosis is recommended. If the OME persists for over 3 months with accompanying hearing difficulty, then intervention is suggested https://www.nice.org.uk/guidance/cg60. When the NICE CG60 guidelines are next revised it is likely that they will change from focusing on surgical intervention (ventilation tubes/grommets) to include non-surgical options (hearing devices (e.g. hearing aids), assistive hearing devices (e.g. FM systems) & optimising listening conditions).

As mentioned in the first blog in this series, the optimum treatment for OME has remained elusive. It is likely that several interventions may be considered for each child, emphasising the importance of good quality evidence and shared decision making- a topic I will return to in the next blog in the series.

Conventional hearing aids (HAs) and ventilation tubes (VTs) are the commonest used interventions for persistent OME in children – as such I will concentrate on these 2 interventions. Medicinal treatments (e.g. anti-histamines & antibiotics) have not been shown to be effective in the management of OME [NICE CG60].

VTs are inserted in children under general anaesthetic (GA) and surgery involves a small incision being made in the eardrum (tympanic membrane/TM). The fluid (effusion) is then aspirated and a VT is positioned in the incision. Whilst the VT is in situ and patent it acts to ventilate the middle ear (ME), preventing the development of the negative pressure and low oxygen levels in the ME, thought to be important factors in the development of OME. Choosing HAs accepts the presence of an effusion in the ME, but amplifies the sound delivered to the ME. The intention being that the level of amplification matches the negative impact of increased resistance to the transmission of sound energy across the ME, resulting from the replacement of a gas with a liquid in the ME.

From a clinician’s perspective, when considering which intervention is the most appropriate, consideration must be given to several key factors, including:

  1. Is the OME associated with significant retraction of the tympanic membrane (TM). Retraction of the TM may be associated with the development of chronic ear disease, and although strong evidence of efficacy is currently lacking, many clinicians will advocate the use of VTs in this scenario.
  2. Likely compliance with the treatment. This is more important when HAs are being considered. It is felt that HAs are more likely to be acceptable to the child when they are younger (nursery or pre-school), with acceptability and compliance decreasing during primary school years.
  3. The presence of OME increases the risk of associated ear infections (acute otitis media/AOM) about 3 fold. When regular ear infections are also present, clinicians will often recommend VTs.

Both interventions have associated risks and implications for the child, which will be discussed in the next blog in this series.