Glue Ear

What is glue ear?

Glue ear or otitis media with effusion is the accumulation of fluid in the middle ear space behind the eardrum. Up to 80% of children will have had an episode of glue ear before starting school. It is more common in boys and most commonly occurs between the ages of 2 and 5.

What causes glue ear?

Glue ear commonly occurs due to the eustachian tubes not working properly. The eustachian tubes are the tubes between the middle ear and the back of the nose. They are responsible for aerating or ventilating the middle ear and draining normal secretions from the middle ear. Glue ear can also develop after a middle ear infection.

What are the symptoms of glue ear?

Glue ear is the most common cause of hearing loss in childhood. You may not notice dulled hearing if your child is young. Older children may say that they can’t hear properly. Mild earache may occur but pain is not usually a main symptom. If the hearing loss persists, then your child may have problems with speech and language development. Some children may develop behavioural problems due to frustration at not being able to follow what is going on at home or at school.

Does glue ear occur in adults?

Glue ear is uncommon in adults, however it can occur after a severe cold or flu. It may also be an indication of a more serious problem at the back of the nose where the eustachian tube opens and an urgent appointment with an ENT specialist is recommended.

How is glue ear diagnosed?

Your GP can usually diagnose glue ear by examining the ears. A hearing test is essential to verify glue ear and determine the severity of the hearing loss. Depending on the outcome of the hearing test, you may be referred to an ENT specialist.

How is glue ear treated?

In about 80% of children, glue ear will resolve spontaneously within a few months. If glue ear persists and is affecting hearing and development then surgery for insertion of grommets may be indicated. Grommets, also known as ventilation tubes, are small tubes that help ventilate and drain the middle ear.

At WestsideENT, we specialise in all aspects of children’s ENT problems. Your specialist will carry out a comprehensive assessment and discuss treatment options with you.

Recurrent Ear Infections

What are the different types of ear infections?

Ear infections are typically divided into those that affect the outer ear canal, known as swimmer’s ear or otitis externa and those that affect the middle ear space, known as otitis media.

Episodes of acute otitis media or middle ear infections are very common during childhood and most children will have had a couple of middle ear infections before the age of 5.

What causes acute otitis media?

Acute otitis media is most often caused by a viral or bacterial infection causing inflammation of the lining of the middle ear space.

The infection often follows a cold or flu which causes swelling of the nasal passages and the eustachian tubes, blocking the eustachian tubes. This results in the accumulation of fluids in the middle ear space which then get infected.

Adenoids are pads of tonsil-like tissue high in the back of the nose near the opening of the eustachian tubes. Adenoid enlargement or infection may also block the eustachian tubes, contributing to episodes of acute otitis media.

What are the symptoms of a middle ear infection?

Symptoms of an ear infection can develop rapidly.

Common symptoms are severe ear pain, pulling at an ear, difficulty sleeping, irritability, hearing loss and fevers.

There may be worsening pain until the eardrum ruptures, resulting in a discharge of pus or bloody fluid. With the correct treatment the eardrum almost always heals as the infection subsides and the hearing returns to normal.

Rarely, patients can develop complications due to a middle ear infection and you should seek urgent medical advice if your child fails to respond to treatment or deteriorates.

How are middle ear infections treated?

Treatment of acute otitis media varies depending on the age of the child and the duration and severity of symptoms.
Your GP will decide on the most appropriate treatment and where necessary will refer you to an ENT specialist for further treatment.

At WestsideENT, we specialise in all aspects of children’s ear conditions and we will work closely with you and your GP to provide the best possible care for your child.

Prominent Ears – Otoplasty

What are prominent ears?

Some children are born with ears that stick out or protrude more than they would like. Prominent or protruding ears are observed in a small percentage of the population.

What causes prominent ears?

Prominent ears result when there has been failure to develop a normal fold in the cartilage of the ear that sets back the ear into what is considered a natural position.

Is treatment for prominent ears indicated?

Prominent ears do not cause any functional problems however children with very prominent ears may be conscious about looking different and may be teased, especially during school years. This can ultimately affect self confidence and self esteem.

How are prominent ears treated?

If it is noticed shortly after birth, splinting the ears to create a more natural fold can be effective.

In older children, surgery is required to reshape the ears as the cartilage is too stiff for splinting to be effective.
Otoplasty is the surgical procedure to change the shape and position of the ears or pin back the ears. Otoplasty is usually done around the age of 4 or 5.

If you are concerned about the appearance of your child’s ears, discuss this with your GP who may refer you to one of our WestsideENT specialists. Your specialist will carry out a comprehensive assessment and discuss treatment options with you.

Tonsils & Adenoids

What are the tonsils and adenoids?

Tonsils are two masses of tissue on either side of the back of the throat. Adenoids are made up of the same type of tissue and are located high in the throat behind the nose. Adenoids are not visible without the use of special instruments.

Tonsils and adenoids are made up of tissue similar to the lymph nodes or glands found throughout the rest of the body. They are part of the body’s immune system, sampling things we eat and breath such as bacteria and viruses and helping the immune system resist and fight infections.

The size of the tonsils varies enormously between individuals. The adenoids typically stop growing around the age of 8 and then gradually reduce in size over time. Even though the tonsils and adenoids are part of the immune system, it is generally accepted that their removal does not increase the risk of infections.

What conditions affect tonsils and adenoids?

The two most common problems affecting the tonsils and adenoids in children are recurrent infections and significant enlargement of the tonsils and adenoids causing breathing and swallowing problems.

Recurrent tonsillitis

Tonsillitis is most often caused by a viral infection but bacterial infections can also occur. The most common bacterial infection is a streptococcal infection.

Common symptoms of tonsillitis are a sore throat, fever, painful swallowing or a reluctance to eat in young children, swollen neck glands and generally feeling unwell. The tonsils may appear red and inflamed and they may also have white or yellow spots of pus on their surface.

Individual episodes of tonsillitis are usually treated by your GP with a combination of pain relief, rest and fluids. In some cases, antibiotics will be prescribed if a bacterial infection is suspected.

Unfortunately, some children develop recurrent episodes of tonsillitis which significantly impact on their quality of life. In these circumstances, removing the tonsils and adenoids may be considered.

At WestsideENT, we specialise in the care of children with ear nose and throat problems and your specialist will discuss with you the best option for your child.

Enlarged adenoids

Enlarged adenoids are common in children and may not cause any symptoms or problems.
If the adenoids become very enlarged, they may cause symptoms such as:

    • Noisy or rattly breathing through the nose.
    • Difficulty breathing through the nose resulting in mainly mouth breathing.
    • A constant runny nose with discharge which is often discoloured.
    • Snoring at night.

Enlarged adenoids may also block the eustachian tubes, contributing to glue ear and recurrent ear infections.

The treatment of enlarged adenoids depends on the severity of the symptoms. In many cases, no treatment is needed. If symptoms are severe, removal of the adenoids may be considered.

Your WestsideENT specialist will carry out a comprehensive assessment and discuss treatment options with you to achieve the best possible outcome for your child.

Snoring and Obstructive Sleep Apnoea – Sleep Disordered Breathing

Snoring and obstructive sleep apnoea (OSA) are part of a continuum of breathing difficulties that occur during sleep known as sleep disordered breathing or SDB. Snoring and sleep apnoea occur when we are asleep as this is when the muscles which keep our throat open are relaxed and more likely to collapse inward, narrowing the airway.

Sleep disordered breathing ranges in severity from snoring at one end of the spectrum to obstructive sleep apnoea (OSA) at the severe end of the spectrum.

Patients with sleep disordered breathing have repeated episodes of partial or complete blockage of the upper airway during sleep.

With partial airway obstruction, there is narrowing of the airway which causes turbulent airflow resulting in the characteristic sound of snoring.

With more severe blockage of the airway, breathing stops which causes a fall in oxygen levels. This triggers a partial awakening accompanied by a choking or gasping noise as breathing is resumed. This can happen multiple times a night, preventing restful sleep.

The most common cause of sleep disordered breathing in children is enlarged tonsils and adenoids so removal of the tonsils and adenoids is generally recommended as first line treatment.

There are differences between paediatric sleep apnoea and adult sleep apnoea. Obesity is a common factor underlying adult sleep apnoea. There are also usually a number of other anatomic and age related factors contributing to adult OSA and as a result, adults are much less likely to benefit from surgery.

How is sleep apnoea diagnosed?

A diagnosis of sleep disordered breathing in children is usually made based on history and physical examination of the upper airway. In some cases, tests such as a sleep study may be indicated.

In addition to snoring and episodes of stopping breathing, children with sleep apnoea may also have daytime irritability, tiredness, bed wetting, behavioural problems and poor attention and concentration at school.

Sleep disordered breathing is often suspected by parents and carers based on observation of their child. If you suspect that your child has sleep disordered breathing, discuss this with your GP who will assess your child and refer them to an ENT specialist.

What is the treatment?

The management of paediatric SDB depends on the age of your child and the severity of their symptoms. As the most common cause of paediatric sleep apnoea is enlarged tonsils and adenoids, adenotonsillectomy can improve or resolve SDB in about 90% of cases.

Your WestsideENT specialist will review your child’s symptoms, assess their upper airway and work with you to determine the most appropriate treatment for your child.


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