managing glue ear

Managing glue ear without surgery – the Otovent.

In a previous blog about glue ear we talked about the things that you could do to help your child hear. In this blog, we will be looking at the use of Otovents to manage glue ear without surgery. Glue ear is where fluid builds up behind the eardrum and in the Eustachian tube. The Eustachian tube connects the middle ear to the throat and it helps equalise the pressure in the ears. When we go up a hill or fly, it is this area of the middle ear that makes our ears ‘pop’. One in five children will suffer glue ear before the age of two years. Eight in ten children will have had glue ear at least once by the time they are ten years old (NICE guidance). For most of these children the glue ear will go away by itself, usually within three months. Unfortunately it can be very persistent in some children. For these children there are often repeat visits to the GP and then an Ear, Nose and Throat (ENT) specialist. Surgery or temporary hearing aids might be recommended. Surgery for glue ear includes draining the fluid from the middle ear (myringotomy) and then inserting grommets (miniature tubes). Occasionally ENT may recommend that the tonsils or adenoids are also removed. See the NDCS leaflet on glue ear. Before referral to ENT the audiologist might suggest parents try an Otovent. This might also be suggested while parents are monitoring their child’s hearing, known as ‘watch and wait’.  

What is an Otovent?

An Otovent is small balloon that is connected to a nose piece (a blue plastic bulb like tube). The nose piece is then placed against one nostril while the other nostril is held closed. The child or adult then inflates the balloon until it is about the size of a grapefruit by blowing through their nose into the blue nose piece. This is then repeated with the other nostril. Pinching your nose and blowing is known as a Valsalva manoeuvre. The Otovent is trying to do something similar. The thinking behind it is that if we can find a way to ‘teach’ the ear to normalise the pressure in the middle ear it may reduce the symptoms. In turn this may reduce the need for surgery.  

How does using an Otovent help glue ear?

Blowing in to the Otovent causes a forced expiration against the closed airway and leads to auto‑inflation of the middle ear. This increases the pressure in the nasopharynx (nose to ear/nose/throat). It’s thought that over time this helps teach the Eustachian tube to become more open. This is turn equalises the air pressure and allows the fluid in the middle ear to drain away down the back of the throat. It is normal for your child to feel increased pressure in the ear or hear a ‘click’ when they are using the Otovent.  

Does using an Otovent work?

CMAJ journal article Information on Otovent research by Southampton University showed positive results. Of those children using the Otovent 64% of them found that their glue ear improved. In contrast 71% of those in the control group who did not use the Otovent found no improvement in their glue ear. You can buy Otovents online, at some chemists over the counter or via prescription. Otovent can be used by children over the age of three.   Regardless of whether you are using Otovent, during your ‘watch and wait period’ you should still have repeat hearing tests for your child. This is in order to monitor their hearing levels and middle ear status.