EAR DISORDERS

Why Do Some Children Develop Mucus in the Middle Ear?

The middle ear is normally an air-filled cavity. It is ventilated by the Eustachian tube, which connects the middle ear to the back of the nose, near the palate and the adenoids.

If this tube becomes blocked—due to infection, allergy, enlarged adenoids, or sometimes for reasons that are not entirely clear—the air in the middle ear is gradually absorbed. This creates negative pressure within the middle ear space.

As a result, the mucus-secreting (goblet) cells, which are normally present in small numbers to provide light moisture, increase in both size and number. These cells begin to produce excessive mucus, which can eventually fill the middle ear cavity.

What Happens When This Occurs?

• Hearing loss may develop. This is often mild to moderate but can be significant enough to interfere with learning. A child may hear well when spoken to directly, but may appear to ignore voices when distracted. This is not poor behaviour or lack of attention—it is simply reduced hearing.

• Recurrent middle ear infections may occur, often accompanied by earache and occasional discharge.

• Irritability is common. The sensation of blocked ears is uncomfortable and can be distressing for a child.

What Are the Long-Term Effects?

In some children, the condition resolves spontaneously as the natural ventilation of the middle ear is restored. When this happens—ideally within 4 to 6 weeks—hearing usually returns to normal and no permanent damage occurs.

If the condition persists, repeated infections may lead to scarring or damage to the eardrum. In the past, this sometimes resulted in a condition known as chronic adhesive otitis, which can cause permanent hearing loss.

How Is This Condition Treated?

The initial goal is to restore the ear’s natural ventilation.

• If infection is present, antibiotics may be prescribed.

• Decongestants and nasal steroid sprays are often used to reduce swelling and improve Eustachian tube function.

If these measures are unsuccessful, artificial ventilation of the middle ear may be required. This is achieved by inserting grommets.

What Are Grommets?

Grommets are tiny plastic or metal tubes with a small central opening. They are inserted through a minute incision in the eardrum using a microscope and specialised instruments. Their function is to ventilate the middle ear and prevent fluid accumulation.

Grommets typically remain in place for 3 to 18 months, depending on the type used. They usually migrate out of the eardrum naturally and are expelled from the ear canal with ear wax. Occasionally, a grommet may become blocked and require replacement.

Regular follow-up visits every 3–4 months are important to ensure the grommet is functioning properly and to confirm that the eardrum returns to normal once the grommet has extruded.

Do Grommets Need to Be Reinserted?

Approximately 75% of children require no further treatment once the grommet has come out.

A smaller group may need repeat grommet insertion if the underlying causes persist and the condition recurs. Only a very small percentage of patients require long-term or permanent grommets.

Swimming and Grommets

This should be discussed individually. In most cases, children with grommets can swim, as the small opening does not easily allow water to pass through.

However, soapy water can enter the middle ear and cause irritation. Care should be taken during bathing and shampooing, and children should avoid lying in bathwater with their ears submerged.

For parents who are concerned, silicone earplugs may be used during prolonged water activities.

HEARING LOSS IN CHILDREN

Approximately 1 in every 1,000 children is born with profound hearing loss, and many more are born with milder degrees of hearing impairment. Others acquire hearing loss during childhood.

Hearing impairment can interfere with speech and language development, and may negatively affect a child’s social, emotional, cognitive, and academic progress. Delayed identification of moderate to profound hearing loss may significantly limit a child’s ability to adapt to a hearing world.

The Importance of Early Detection

The first three years of life are critical for speech and language development. Although several screening methods are available during infancy, the average age at which hearing loss is identified remains close to three years. Milder forms of hearing loss may go undetected for even longer.

Recent research has shown that children with normal cognitive abilities who are identified and managed before six months of age can develop language skills comparable to their peers.

Hearing screening can be performed at any age, including shortly after birth. All children should have their hearing tested before starting school, as even mild or one-sided hearing loss—though not obvious—can adversely affect learning and language development.

If you suspect your child may not be hearing normally, even if others are not concerned, it is advisable to have their hearing assessed by an audiologist, and when appropriate, their speech evaluated by a speech and language therapist.

Risk Factors and Warning Signs of Hearing Loss

Pregnancy

• Maternal infections such as German measles or cytomegalovirus

• Alcohol or drug use during pregnancy

Newborn (Birth to 28 Days)

• Low APGAR scores

• Low birth weight (less than 1.5 kg)

• Admission to a neonatal intensive care unit, particularly if ventilation was required

• Bacterial meningitis

• Severe neonatal jaundice requiring medication or transfusion

• Craniofacial abnormalities

• Use of intravenous ototoxic antibiotics

• Family history of permanent hearing loss

Infant (29 Days to 3 Years)

• Parental or caregiver concern regarding speech, language, or developmental delay

• Recurrent middle ear infections

• Bacterial meningitis

• Exposure to ototoxic antibiotics

• Neurological conditions or head injury