Direct answer
Glue ear, or otitis media with effusion, is fluid behind a child’s eardrum without acute ear infection. It may cause fluctuating hearing loss, unclear speech, poor concentration or few obvious symptoms. Diagnosis requires ear examination and age-appropriate hearing assessment, often with tympanometry. Persistent hearing loss affecting communication, development or school may require hearing support, grommets or selected adenoid surgery.
Symptoms
- Not responding to quiet speech
- Frequently asking for repetition
- Increasing television or device volume
- Watching the speaker’s face or moving closer to hear
- Concerns about speech clarity or language development
- Poor concentration, tiredness or frustration
- A blocked-ear sensation, mild balance difficulty or fluctuating hearing
Possible causes
- Fluid remaining after a cold or respiratory infection
- Smaller, more horizontal Eustachian tubes in children
- Recurrent middle-ear infections
- Enlarged adenoids or persistent nasal obstruction
- Cleft palate or certain craniofacial conditions
- Exposure to tobacco smoke
- No identifiable cause in some children
How it is assessed
- Review symptom duration, infections, speech, development and school impact
- Examine the eardrum with otoscopy or pneumatic otoscopy when appropriate
- Use tympanometry to assess eardrum movement and middle-ear function
- Arrange age-appropriate hearing testing
- Assess speech-language, nasal obstruction, adenoids, snoring or sleep symptoms when indicated
Treatment options
- Active observation with planned follow-up when hearing loss is not substantially affecting daily life
- Gain attention before speaking, talk clearly face-to-face, reduce background noise and support classroom seating
- Consider clinician-guided autoinflation for a child who can perform it reliably
- Do not routinely use antibiotics, oral or nasal corticosteroids, antihistamines or decongestants for uncomplicated OME
- Consider air-conduction hearing aids or selected bone-conduction devices when persistent loss affects communication or learning
- Discuss grommets through shared decision-making when persistent OME-related hearing loss has important functional impact
- Consider selected adenoidectomy with grommet surgery when nasal obstruction, adenoid disease or recurrence is relevant; use special caution with palatal abnormalities
When to seek emergency care
- Redness, pain or swelling behind the ear with the ear pushed outward
- Marked lethargy, confusion or severe illness
- New facial weakness
- Severe vertigo or inability to walk normally
- Sudden significant hearing loss
- Severe earache, high fever or ear discharge
At a glance
Definition: Glue ear, or otitis media with effusion, is fluid behind a child’s eardrum without acute infection. It may cause fluctuating hearing loss, unclear speech, poor concentration or few obvious symptoms.
Key takeaways
- Glue ear can reduce hearing without pain or fever
- OME is different from an acute ear infection
- Otoscopy, hearing testing and tympanometry guide management
- Observation is appropriate for many children
- Persistent functional problems may justify hearing support, grommets or selected adenoidectomy
Clinical steps
- Gain the child’s attention, speak face-to-face and reduce background noise
- Inform nursery or school and arrange seating near the teacher
- Monitor hearing, speech development and school performance
- Reassess hearing as planned and use shared decision-making according to impact
Red flags: Seek urgent assessment for redness or swelling behind the ear, the ear being pushed outward, marked lethargy or confusion, new facial weakness, severe vertigo, sudden significant hearing loss, high fever or ear discharge.
How I assess this in clinic
In Bangladesh, children with fluctuating hearing loss are sometimes labelled inattentive or uncooperative. Conversely, repeated antibiotics may be given whenever fluid follows a cold, even when there is no acute bacterial infection or dependable long-term benefit.
I combine ear examination, tympanometry, age-appropriate hearing testing and the child’s speech, development and classroom function.
An enlarged adenoid on imaging or one episode of middle-ear fluid alone should not determine surgery. The decision should reflect duration, measured hearing loss, developmental risk and the effect on the child’s daily life.
Helping families and teachers improve the listening environment is also an important part of care.
Frequently asked questions
Can glue ear cause permanent deafness?+
Most associated hearing loss is temporary and conductive. Persistent or recurrent OME can nevertheless affect listening, communication and learning, so follow-up matters.
Is a hearing test needed when there is no pain?+
Yes, when there are concerns about hearing, speech, behaviour or school performance.
Does my child need an antibiotic?+
Routine antibiotics are not recommended for uncomplicated OME without acute bacterial ear infection.
Do grommets guarantee that glue ear will never return?+
No. Grommets can improve hearing, but fluid may recur and some children need further follow-up or treatment.
Does speech delay always mean glue ear?+
No. OME is one possible contributor. Comprehensive hearing, developmental and speech-language assessment may be needed.
Related ENT services
Paediatric ENTENT assessment for childhood ear infections, hearing concerns, adenoids, snoring, tonsils and delayed speech development.→Ear ConditionsAssessment of ear pain, infection, eardrum perforation, tinnitus, cholesteatoma and hearing loss.→Hearing TestsAge- and symptom-appropriate tests help identify the type and degree of hearing loss.→For patient education; not a substitute for individual diagnosis or treatment. Seek emergency care for red-flag symptoms.