Fluctuating Conductive Hearing Loss

Understanding glue ear, middle ear fluid and what it means for your child’s hearing and development.

1 in 3

primary aged children experience hearing loss due to middle ear fluid at any given time

80%

of children will experience at least one episode of middle ear fluid by the age of 10 years

12 weeks

most cases of fluid spontaneously resolve within this timeframe

Audiologist performing a hearing test on a child

How does fluctuating conductive hearing loss develop?

A conductive hearing loss develops as a result of a problem in the middle or outer ear. There are several causes, but in pre-school and young children conductive hearing loss usually occurs if the Eustachian tube becomes blocked. The air in the middle ear cavity is absorbed and replaced by fluid. This can become thick and “glue-like” , hence the term “glue-ear” . In some cases this fluid can become infected, resulting in a middle ear infection.

With the middle ear full of fluid, the conduction of the sound is interfered with. Sounds become muffled and difficult to distinguish, like your head is under water. The fluid can come and go as the Eustachian tube becomes unblocked and then re-blocked. This is why it is called fluctuating conductive hearing loss. Because of this the degree of hearing loss can vary. The hearing loss can also appear, disappear and reappear.

It is important to know that hearing loss can be present even before fluid begins to build up and without an infection being present. This can make hearing loss difficult to detect without a formal hearing assessment.

How do we hear?

There are three parts to the ear:

The outer ear
collects sounds and directs them down the ear canal to the ear drum. The ear drum separates the outer ear from the middle ear.

The middle ear
mechanically conducts sounds to the inner ear. The middle ear is a small cavity filled with air and contains three tiny bones (the smallest bones in your body!) which form a chain to help conduct sounds from the ear drum to the inner ear. A tube called the Eustachian tube connects the middle ear to the back of the nose and throat. It opens regularly as we chew and swallow to keep the correct air pressure in the middle ear.

The inner ear
changes these mechanical sounds into electrical impulses and sends them to the brain where they are recognized and understood.

Important signs to look for

If your child shows any of these signs, a hearing assessment is recommended as soon as possible.

Delayed speech and language development
Unclear or “slushy” speech
Unresponsive to soft speech
Not hearing when called from another room
Not hearing when there is background noise present
Often saying “pardon”
Preferring the television volume turned up loud, but hating sudden or unexpected loud noises
Watching faces intently during conversations
Complaining of “noises” in the ear, especially at night
Not remembering instructions
Shouting or whispering while speaking
Sometimes seeming to be more naughty than at other times
Clumsiness
Lacking in concentration
Experiencing difficulties at school
Easily distracted and/or distracting other students in class

Treatment

Whilst alternative methods of treatment may be considered, decongestants are usually prescribed by a GP for middle ear fluid and antibiotics if there is a middle ear infection. Most conductive hearing losses resolve spontaneously, but if they don’t referral to an ear, nose and throat (ENT) specialist is recommended. An ENT can investigate the cause of the recurring middle ear problems, such as allergies, swollen tonsils & adenoids or structural problems, and provide appropriate management options.

Sometimes a grommet (tiny tube) is inserted into the ear drum(s) to ventilate the middle ear(s) and restore normal hearing. The Eustachian tube can continue to be blocked but the middle ear pressure is kept correct by the grommet. Grommets are not felt by the child and usually come out of their own accord between 6 and 12 months, leaving the ear drums intact.

What to do if you suspect hearing loss

If you are suspicious about your child’s hearing make an appointment for a hearing test as soon as possible. We can determine if there is a hearing loss and the cause of the hearing loss. Appropriate management can then be discussed.