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Scenario

Technician Vicky is at the pharmacy counter when Nadia Begum comes in.

“Hi Nadia – you haven’t been in for ages. How is Abshar?” asks Vicky.

“Oh, he’s OK now, thanks for asking,” replies Nadia. “We finally got to the bottom of all the problems he’s been having at school – he has glue ear.”

“Ah, that makes sense,” says Vicky. “So it turned out that the reason his behaviour wasn’t so good and the teacher kept saying he wasn’t listening wasn’t because he was playing up but because he couldn’t hear. Is he to have grommets fitted?”

“He’s already had it done!” says Nadia. “I know it’s a pretty straightforward operation, but any surgery is nerve-wracking when it’s your child being wheeled into theatre. Still, he is fine, but I can’t believe some of the stuff they told us when we left hospital. You know, they said he can go swimming, but I remember very clearly my brother not being able to go in the pool at all when he had grommets as a child. And apparently he doesn’t need to have them removed – they will just fall out all on their own. Can you believe such nonsense?”

Answer

Nadia has been given the correct advice on both counts.

Some surgeons advise that swimming is avoided while a child has grommets because an ear infection may develop if water gets into the middle ear through the tiny tube (grommet) that is placed in the eardrum. However, others say that it is OK to swim, as long as a few precautions are taken. These include allowing a few weeks to elapse after the grommets have been fitted, wearing a tight fitting cap while swimming, not diving/jumping into water and avoiding water that is not chlorinated.

Grommets do not need to be surgically removed. As the tympanic membrane (eardrum) heals, the tube is slowly pushed further and further out and eventually falls out. This takes six to 12 months and is usually painless.

The bigger picture

Glue ear – or otitis media with effusion (OME) as it is medically known – is incredibly common, affecting up to 80 per cent of children. It most commonly follows an episode of acute otitis media – as is the case for Abshar – although sometimes the cause is not known. The most common symptom is hearing loss, although this often manifests as problems at school or nursery such as not listening to instructions or a slowdown in speech or language development. Some children also complain of earache or experience a loss of balance and coordination.

In many cases, glue ear gets better without any treatment. However, if there is significant hearing loss or it is having a major impact on behaviour or development, grommets or hearing aids are fitted. Grommets are tiny tubes that are put in the eardrum to help fluid drain and maintain the circulation of air. The fitting operation is quick and relatively routine, but like all surgery carries an element of risk: ear infection and perforation of the tympanic membrane are the most common. Hearing aids are an alternative for children who cannot or do not want to have surgery and allow them to hear while nature takes it course and the ear heals on its own.

Extend your learning

• This scenario mentions some parts of the ear that you may or may not be familiar with. Check your understating by reading about the anatomy of the ear
• Children who have glue ear are often referred for a hearing test – something that parents and carers may feel anxious about. Read up on what happens at these appointments so you can provide reassurance
• Find out about the contributing factors to the development of glue ear and the advice that pharmacy staff can offer to help prevent the condition
• Parents and carers may worry about how their child will fare at school if he or she has glue ear. Have a look at the advice provided by the National Deaf Children’s Society at.