Long Term Effects of Glue Ear

Long Term Effects of Glue Ear

It is estimated that 70% of children with chronic glue ear develop mild-to-moderate hearing loss (Daly et al, 1999).

Much has been written and observed about the short-term, daily frustrations of living with glue ear-related hearing loss in childhood, but information about the longer-term effects is less well known.

Indeed, one of the key challenges posed by glue ear-related hearing loss is that it often occurs at an age when children are in a critical period of auditory and language development (Nittrouer and Lowenstein, 2024).

There remains debate around the longer-term impacts of glue ear, but a consensus does seem to be emerging that glue ear does have a deleterious effect in the long-term.

This article briefly looks at some of the key areas where glue ear-related hearing loss can have a negative impact on a child’s long-term development.

Auditory Processing and Long-Term Hearing Loss

Auditory processing skills include the ability to distinguish between different sounds or words, the ability to store and recall sounds, the ability to tune into a particular source of sound, perception of loudness, and the ability to process one sound in the presence of background noise (Riggs, 2009). As such, they underpin language, communication, and comprehension.

A 2019 study conducted across several universities including UCL and the University of Cambridge showed that ‘even mild to moderate hearing loss in early-mid childhood can lead to changes in the neural processing of sounds in late childhood/adolescence’ (Calcus et al, 2019).

A 2017 study by Halliday et al pointed to a probable link between poor auditory processing and poorer language skills (Halliday et al, 2017).

A 2015 study by Aarhus et al researched the extent to which childhood otitis media (acute, suppurative and with effusion) is associated with adult hearing loss. This in turn found that children who experienced hearing loss as children caused by otitis media ‘had significantly reduced adult hearing thresholds’ (Aarhus et al 2015).

A 2024 review of the literature on otitis media and resulting hearing loss identified a trend of ‘poor academic and behavioural outcomes, largely aligning with long-term outcomes of hearing loss, as well as ongoing poor audiological functioning’ although there remain large gaps in the research literature (James et al, 2024).

Speech and Language Development

This tends to be the top concern of parents.

Moderate hearing loss can make speech and language acquisition more challenging because different speech sounds occur at different frequencies. Glue ear hearing loss affects the lower frequencies first, (sounds like M, N, B and D) and then as it progresses, it begins to affect higher frequencies.

Higher frequency sounds like p, k, f, s and th are harder to pick out with glue ear and it can be harder to discriminate between words with these sounds. E.g. kite and fight.

As far back as 1982, researchers found that children with bilateral OME were significantly disadvantaged in their ability to articulate speech and verbal comprehension (Silva et al, 1982), while a 2024 study found that when experimental factors are tightly controlled, children with a history of OM perform more poorly than unaffected peers on a range of language and auditory measures (Nittrouer and Lowenstein, 2024).

Social and Behavioural Issues

As far back as 1987, an association between frequency of otitis media in childhood and later hyperactivity was reported (Hagerman and Falkenstein, 1987), while a 2008 study found that otitis media was associated with increased severity of ADHD and learning difficulties (Padolsky, 2008).

A longitudinal study in the UK found that after adjusting for other variables, the developmental sequelae of middle ear diseases were most prominent in terms of behaviour problems and language test data at the age of 5, but still significant at age 10 (Bennett and Haggard, 1999).

Where to from here?

The literature is clear that there remain large gaps in our knowledge of the long-term effects of glue ear. This is not helped by the fact that the fluctuating and often self-resolving nature of the condition makes it difficult to research reliably.

However, the existing literature can paint a worrying picture for parents of children with glue ear.

One obvious way forward is to act quickly to tackle the glue ear behind the hearing loss.

Otovent autoinflation treatment has been shown to cause significant improvements in middle ear function compared with standard care (NICE, 2016; Williamson et al, 2015;) and to be effective in the short term (Blanshard et al, 1993; Stangerup et al, 1992; Perera et al, 2013).

As a cost-effective and affordable treatment with a proven track record, prescribing or recommending Otovent could be an excellent first step to helping children relieve the symptoms of glue ear.

Bibliography

Aarhus L, Tambs K, Kvestad E, Engdahl B. Childhood Otitis Media: A Cohort Study With 30-Year Follow-Up of Hearing (The HUNT Study). Ear Hear. 2015 May-Jun;36(3):302-8.

Blanshard JD, Maw AR, Bawden R. Conservative treatment of otitis media with effusion by autoinflation of the middle ear. Clin Otolaryngol Allied Sci. 1993 Jun;18(3):188-92.

Conlon C, Zupman B, Pirie E, Gupta C. The Impact of otitis media on speech production in children: a systematic review, Journal of Communication Disorders, Vol. 113, 2025.

Daly K. A., Hunter L. L., Giebink G. S. (1999) Chronic otitis media with effusion. Pediatrics in Review 20: 85–94.

Hagerman RJ, Falkenstein AR. An association between recurrent otitis media in infancy and later hyperactivity. Clin Pediatr (Phila). 1987 May;26(5):253-7

Halliday LF, Tuomainen O, Rosen S (2017a) Auditory processing deficits are sometimes necessary and sometimes sufficient for language difficulties in children: evidence from mild to moderate sensorineural hearing loss, Cognition 166:139–151.

James, R., Machell, A., DeLacy, J., & Stephens, J. (2024). Long-term outcomes of childhood otitis media and hearing loss: a systematic review. Speech, Language and Hearing, 1–14.

NICE, Otovent nasal balloon for otitis media with effusion, Medtech Innovation Briefing, March 2016.
Nittrouer S, Lowenstein JH. Early otitis media puts children at risk for later auditory and language deficits. International Journal of Pedriatric Otorhinolaryngology, Vol 176, 2024.

Padolsky I. J. (2008) The neuropsychological and neurobehavioral consequences of ADHD comorbid with LD and otitis media. Journal of Developmental and Physical Disabilities 20: 11–20.

Perera R, Glasziou PP, Heneghan CJ, McLellan J, Williamson I. Autoinflation for hearing loss associated with otitis media with effusion. Cochrane Database Syst Rev. 2013 May 31;2013(5):CD006285.

Riggs L, Auditory Processing – What is It? (Hearing vs. Processing), NACD Journal, Vol. 22, No. 11, 2009.
Silva, P. A., Kirkland, C., Simpson, A., Stewart, I. A., & Williams, S. M. (1982). Some Developmental and Behavioral Problems Associated With Bilateral Otitis Media with Effusion. Journal of Learning Disabilities, 15(7), 417-421.

Stangerup SE, Sederberg-Olsen J, Balle V. Autoinflation as a treatment of secretory otitis media. A randomized controlled study. Arch Otolaryngol Head Neck Surg. 1992 Feb;118(2):149-52.