Question 1

My child passed their newborn hearing screen but now seems to be struggling to hear. Could glue ear develop after a normal result at birth?

Accepted Answer

Yes, and this is a very common source of confusion. The newborn hearing screen tests for sensorineural hearing loss - a problem arising from the inner ear or auditory nerve - that is present from birth. Glue ear is a conductive hearing loss that develops later in childhood in response to Eustachian tube dysfunction and respiratory infections. A completely normal newborn screen provides no protection against glue ear in the years that follow. A child who heard perfectly well at birth can develop significant hearing loss from glue ear by the age of two or three, which is why any new concern about hearing at any age deserves formal assessment regardless of earlier results.

Question 2

Can glue ear affect only one ear, and does that still matter if the other ear seems to be working normally?

Accepted Answer

Unilateral glue ear is entirely possible and is frequently underestimated. When one ear is normal, it is tempting to assume the child will compensate. In practice, the brain relies on input from both ears to accurately locate where sounds are coming from. When one ear is impaired, this binaural hearing ability is compromised, making it harder to follow a single voice against background noise. A child with unilateral glue ear may perform well in a quiet one-on-one setting yet struggle significantly in a noisy classroom. Assessment is worthwhile for unilateral cases, particularly when the effusion has persisted for more than three months.

Question 3

How can I tell the difference between my child being inattentive and a hearing problem caused by glue ear?

Accepted Answer

This is one of the most important questions parents can ask, because the two conditions can present almost identically. Both can produce a child who appears to ignore instructions, drift in group activities and struggle to concentrate. The key distinction is context. A child with glue ear will typically respond much better in quiet, one-on-one settings where visual cues are available, and will struggle specifically in noisy, reverberant environments like classrooms and playgrounds. They may also lip-read without awareness of doing so. Any child who is being assessed for attention or learning difficulties should have a formal hearing test and tympanometry before other diagnoses are pursued, as addressing an underlying hearing loss can sometimes resolve the apparent behavioural concerns entirely.

Question 4

If my child has already had grommets and the glue ear has come back, does that mean the first surgery did not work?

Accepted Answer

Not at all. The return of glue ear after natural grommet extrusion is not a sign that the first surgery failed. The grommets achieved exactly what they were designed to do: they restored hearing, maintained middle ear health and protected a critical developmental window for the duration they were in place. The recurrence of fluid after extrusion reflects the fact that the underlying Eustachian tube dysfunction has not yet fully resolved, which is a maturational process that continues throughout childhood. A second set of grommets is a well-established clinical response, and at this stage the addition of adenoidectomy is frequently recommended to address one of the most common contributors to recurrent dysfunction and reduce the need for further procedures.

Question 5

Can diet, feeding practices or environmental changes reduce the risk of glue ear developing or coming back?

Accepted Answer

There is genuine evidence supporting certain preventive strategies, though none guarantees immunity. Eliminating passive smoke exposure in the home and car is one of the most evidence-supported steps parents can take. Breastfeeding in infancy is associated with lower rates of middle ear disease. Managing nasal allergies appropriately reduces the chronic inflammation that impairs Eustachian tube function. Keeping immunisations current reduces the frequency and severity of the respiratory infections that trigger episodes. Nasal saline rinses help keep the nasal passages clear and reduce the inflammatory burden on the Eustachian tube. None of these steps will prevent every episode, but collectively they represent a meaningful and evidence-informed approach for children known to be susceptible.

Question 6

After grommets are inserted, will hearing restoration automatically fix my child's speech delay, or is speech therapy still needed?

Accepted Answer

Grommet surgery removes the physical barrier to further language development and restores access to clear auditory input from that point onwards. However, for children who have experienced a prolonged period of hearing loss during a critical developmental window, the gaps that have accumulated in vocabulary, phonological awareness and speech sound production do not automatically close the moment hearing returns. The brain needs time and quality auditory experience to consolidate what was missed, and some children benefit considerably from targeted speech and language therapy to accelerate that catch-up process. Dr Braham routinely considers a referral to a speech pathologist for children who show signs of speech or language delay related to their glue ear, and families are encouraged to raise communication concerns directly at their Melbourne ENT consultation.

Question 7

At what age do most children grow out of glue ear, and is there a point at which it stops being a concern?

Accepted Answer

The peak incidence of glue ear is between the ages of one and five years. As children grow and their facial skeleton matures, the Eustachian tube gradually lengthens, becomes more vertically oriented and begins to function more efficiently. By the age of seven or eight, the majority of children with a history of glue ear no longer require ongoing intervention. However, waiting for this natural resolution is not always the right approach. The years between birth and school entry are the most sensitive period for language and learning development, and allowing hearing loss to persist untreated throughout this window in the hope of eventual spontaneous resolution can have consequences that are far harder to address later. The question of when to treat and when to watch is best answered through an individualised assessment with Dr Simon Braham at Melbourne ENT.

Category: Paediatric ENT

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