Education Support ServiceHearing Support Team

What is Glue Ear 2

Conditions that Influence Glue Ear 3

Interpreting an Audiogram 4

Examples of Audiograms 5

Grommets and Hearing Aids 6

Daily Checks and Batteries 7

Cleaning and Keeping the Aid Dry 8

Hearing Aid Problem Solving 9

Alternative Treatments for Glue Ear 10

Strategies to Make Hearing Easier 11

Protocol for Supporting Children / Young People with Glue Ear

12

Useful Contact Details 13

Appendix 1 – Copiable Audiogram 14

If you require this information in large print or any other format, please contact Customer Services on 01793 445500 or E-mail: customerservices@swindon.gov.uk

This document was produced by Swindon Borough Council’s EducationSupport Service – Hearing Support Team. FOI Number 2931

Glue Ear

It is believed that more than 7 out of 10 children will have suffered from at least one episode of glue ear. We know glue ear causes intermittent deafness but because it is not easily visible, glue ear may go undiagnosed for sometime. The long-term impact of mild to moderate deafness can be delayed speech development, poor concentration and slow educational progress. If you suspect a child has glue ear, an appointment should be made to see their GP. However, if the deafness persists, an appointment with an ENT Consultant will need to be made. The Consultant may feel it necessary to discuss further interventions such as grommets and hearing aids.

What is glue ear?

Glue ear occurs when air in the middle ear cavity is replaced by mucous. This is usually brought on by a cold or an allergy. Initially, the mucous blocks the eustacian tube which later leads to more mucous being created in the middle ear. This results in everyday- sounds entering the ear becoming dulled as the three bones in the cavity are no longer able to move so freely.

cochlea Ossicles (bones)

Glue ear occurs here ear

drumear canal

Eustacian tube

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What effect does glue ear have?

Having glue ear is similar to the experience of having water trapped in our ear canals after having been swimming, all sounds are dulled and listening becomes hard work. Children especially, may quickly become tired and irritable when they unable to hear properly.

Changes in behaviour can include:• being uncharacteristically tired or frustrated• lacking concentration• preferring to play alone and not responding when called• being disruptive

What conditions influence glue ear?

There are many different factors that may contribute to glue ear. These include:

• colds and flu

• allergies

• passive smoking

• damp environments

• cleft lip and palate

• genetic conditions

Children with Downs Syndrome are more likely to suffer from glue ear as they tend to have narrower Eustacian tubes. The narrower a person’s Eustacian tubes the less easily mucous is able to drain away.

Ear infectionsEar Infections occur when mucous in the middle ear becomes infected. When this occurs the mucous expands, creating pressure on the eardrum which can eventually lead to it splitting. The tear in the eardrum is called a perforation and this, needless to say can be very painful. If a child already wears a hearing aid and also has an ear infection they should wait until the infection has cleared up before using the aid again.

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oi a r

Interpreting an audiogramAn audiogram is a visual record of a person’s hearing. It is written- up after a hearing test, usually by the Audiologist. The horizontal axis shows a range of pitch frequencies (in Hertz), from lowsounds on the left moving across to high sounds on the right. Thevertical axis shows the increase in volume as you move down the graph. This is measured in decibels (dB).

The audiogram below shows the sounds of speech in relation to common environmental sounds. Speech sounds at conversational level are registered between 20 and 60dB.Normal hearing in humans is considered to lie between 0dB and20dB. A hearing aid can make speech louder and bring the point at which a person starts to hear sound, closer to normal. Bylooking at an audiogram we can tell which speech sounds the child is likely to hear and which ones they are not.

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Hearing 0Lossin dB 10

20

30

40

50

60

70

80

90

100

ZV

J mdb nng el u

kph g

i a r cho sh

f th s

110125 250 500 1000 2000 4000 8000

Frequency in Hertz

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Examples of audiograms showing mild and moderate hearing losses.

Frequency in Hertz (Hz)

250 500 1000 2000 4000

0Hearing 10 loss in 20 decibels 30 (dB) 40

5060

A mild loss

Results between0dB and 20dBare considered to be normal.

A child/young person with a m ild l o s s such as this may have difficulty in hearing some high frequency speech sounds like ‘s’,’ th’& ‘k’. The reason for this is that these sounds occur at around20dB when we speak normally. If a child is unable to hear sounds in other people’s speech, it is likely that they will miss out thesesounds in their own speech. Such problems can also have animpact on the child’s spelling ability.

Frequency in Hertz (Hz)

250 500 1000 2000 4000

010

Hearing 20 loss in decibels 30(dB) 40

5060708090

A moderate loss

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A child with a m o de r a te h ea r i ng l o s s will have even greater difficulty in understanding others when they speak. Starting to hear at around 50dB means that most speech sounds will not be picked up. Their own speech production is likely to be affected and they may become difficult to understand. A lack of confidence and low self-esteem is not uncommon as these children becomedependent upon other people’s use of deaf friendly strategies.

Grommets

These are tiny plastic tubes that are put into the eardrum during a short operation under general anaesthetic. The grommets are inserted in order to allow air to circulate in the middle ear and stop more fluid from building up. They usually stay in place until the eardrum naturally pushes them out as a part of the body’s own healing mechanism.

Hearing Aidsgrommet

Sound, muffled by glue ear, can be made louder by a hearing aid. The aid allows stronger sound signals to pass into the cochlear and be interpreted by the brain. Professionals acknowledge that aids have an effective distance of 2 metres. Beyond this distance, background noise is likely to be amplified which has the effect of masking speech.

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Daily checks for hearing aids

1. Visually inspect the aid and ear mould for any physical defects or blockages.

2. Check the tubing is not blocked or damaged.3. Make sure the battery is in the hearing aid correctly.4. Switch on the aid and cup it in your hand. The hearing aid

should produce a high-pitched whistling sound.

See the Problem Solving Chart on page 9 if the aid does not work.

Hook Microphone

TubingVolume Wheel

MouldOn / off switch

Mould to right ear

BatteriesBattery Drawer

Batteries can last from 1 to 3 weeks depending on the hearing aid. You should try to get into a routine of changingthe batteries before they run out completely; Sunday evening/Monday morning is a good time for this as the aid will then be prepared for the school week.

Batteries are obtained from Audiology at the GreatWestern Hospital (Tel: 01793 604065) Just send the old packet to them with your child’s details and they will post new batteries back free of charge.

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CleaningSeparate the mould from the hook of the hearing aid. The mould and its tubing can be put into warm soapy water and wiped clean. If you have a ‘puffer’ this will enable you to dry the inside of the tubing quickly (alternatively, blow through the tube).

Larger pieces of wax might need removing with a fine screwdriver or the end of a paperclip.

1

2

1. puffer2. mould3. paperclip

3

Keeping the aid dry

The hearing aid will break down if it is exposed to water. Some children sweat a lot during the summer and of course children also get caught in the rain. To dry the aid you need a silicone crystal tablet and an air-tight pot, these are usually supplied by the Audiologist at the time the hearing aid is fitted. The aids should be placed in the pot along with a tablet and the lid put on. They then need to be left in the pot overnight.

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Problem Solving

Problem What to check What to doHearing aid is not working.

Still not working?

Condensation in the tubing?

Earmould blocked with wax?

Is the battery working?

• Remove earmould and use puffer to blow out droplets.

• Remove earmould and clean with warm soapy water.

• To dry, blow air through tube with puffer

• Check mould goes back on properly.

• Change the battery.• Return the aid to

Audiology if problem persists.

Buzzing noise in aid. Has the aid been put in water?

• Open battery compartment, remove battery and allow aid to dry out.

• Place aid in care-kit pot with silicone tablet overnight.

Aid is crackling or working intermittently.

• If problem persists, family to return the aid to Audiology.

Aid is whistling Is the earmould in the ear properly?Is the earmould loose? Is there a hole in thetube?Is hair caught behind the mould?Is there somethingobstructing the microphone, eg: hat, side of chair, child resting head on arm? Is there a hole in the tubing?

• Reinsert earmould• Arrange for new

moulds to be made• Replace tubing or

contact Audiology.

• Remove obstruction

Lost an earmould /earmould continues to whistle?

Phone Audiology and arrange to have a newmould impression made.

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Alternatives Treatments

It should be noted that NICE (The National Institute of Clinical Excellence) at the current time can not recommend alternative treatments for glue ear other than those provided by the NHS. This is due to a lack of research in to these treatments and hard scientific evidence of their benefits. The National Deaf Children’s Society however report that there remain many parents who request information about alternative treatments. Contact details of some of these have therefore been included below.

Homeopathy

Homeopathy aims to stimulate the body’s own natural immune system to fight off disease and infection. Homoeopaths use small amounts of naturally occurring substances, usually plant extracts, to do this. For details of practitioners contact the British Homeopathic Association for more information at:

Hahnemann House29 Park Street WestLuton, LU1 3BE.Phone: 0870 444 3950(voice). The line is open between 9am and 5pm, Monday to Friday. Fax x: 0870 444 3960Website: www .tr ust hom eo path y. or g

Diet

Some medical professionals believe that dairy products as well as sugar can increase the level of mucous the body creates. By reducing the intake of such foods it is felt less mucous will be produced. (Please consult your GP before embarking on this course of action.)

Osteopathy

Osteopathy focuses on bones and muscles in the body. By ensuring that these are correctly aligned it is believed the body is more likely to protect itself against ailments.The General Osteopathic Council registers qualified Osteopaths and sets standards of osteopathic practice and conduct.

Phone: 020 7357 6655 (voice). The line is open between 9am and5pm, Monday to Friday, Fax: 020 7357 0011

Website: www.ost eo path y. or g.uk

AllergiesAllergies to pollen or dust mite for example, can cause the eyes to stream and noses to get blocked. Prolonged periods of blocked nose can lead to glue ear and so remedies should be sought. Your GP will be able to advise you on how best to go about being tested for allergies and the medications available to treat them.

How can I make hearing easier for the child?

It is important that glue ear is identified as soon as possible and that parents and teachers know how it can affect children’s hearing. Some basic communication tips can help to make listening and school life easier for the child.

Communication Tips

• Make sure you have the child’s attention before you start talking. Establishing eye contact is essential.

• Lip-reading is difficult. Make sure there is good lighting in the room and avoid moving around too much.

• Speak clearly at a normal pace.

• Try not to obstruct your face or turn away when you are speaking.

• Be patient, rephrase if the child does not understand. What you have said might be hard to lip-read.

• Use visual prompts such as pointing to the object you are referring to or photographs if appropriate.

• Repeat or paraphrase questions or comments from other pupils, especially those that the child cannot see.

Listening for long periods of time in school can be tiring for every child / young person but probably more so for the deaf child. As well as trying to understand the content of the lesson, they also have to constantly fill in the gaps left by words they have not heard properly.

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Education Support ServiceHearing Support Team

Protocol for Supporting Children / Young People with Glue Ear

After a child/young person has been diagnosed and fitted with a hearing aid or hearing aids :

• they will be visited by an Advisory Teacher of the Deaf and an Assessment Report will be written. Usually, three visits are made at this initial stage in order to assess the child over time in the educational setting and to offer specialist support.

• along with the Assessment Report, the school or pre-school setting and parents/guardian will be given the Glue Ear Support Pack for the child/young person with glue ear.

After this:

• the child/young person who has glue ear and has a hearing aid(s), but has no additional needs, will be visited annually in order to monitor progress over time.

• the child/young person with glue ear who has a hearing aid(s) and has additional problems will be visited three times a year where it is agreed to be necessary.

• the Advisory Teacher of the Deaf will continue to take part in Transfer Reviews in Years 1, 5, 9 and 11 for those children/young people who have a Statement of Special Educational Needs.

• if the child/young person moves to a new school, an Advisory Teacher of the Deaf will ensure that the new school is aware of the child’sneeds. (Both school and parents need to inform the ESS of any change of school and/or address).

• Education Support Service - Hearing Support Team will be available to offer advice at any time throughout the year.

There is a way for parents and carers to raise issues with Senior Officers in Education, Health and Social Services. It is called the SEN Forum and it meets twice a year. For details contact Susan Bennett (Parent Partnership) Tel 01793 466515 or email: sbennett@s w i ndo n .gov.uk

T h i s document w a s pro d uced by S w i ndon B o r ough C ounc i l’ s E ducat i on Support Serv ice – Hear ing Supp ort T eam. F OI Number 2931

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Useful contact details

The Hearing Support Team

Roger Thurlbeck (Senior) .........Mobile: 07740 037338Adrienne Lodge ........................Mobile: 07795 665536Ian Sharp ..................................Mobile: 07740 038025Marilyn Gough...........................Mobile: 07824 868411

(All members of the Hearing Support Team are experienced Teachers of The Deaf)

Red Oaks Primary School,Redhouse Way,Swindon.SN25 2ANTelephone: 01793 493920

E m a i l ad d re s s es of t he t e am

rthurlbeck@redoaks.swindon.sch.uk

isharp@redoaks.swindon.sch.uk

mgough@redoaks.swindon.sch.uk

alodge@redoaks.swindon.sch.uk

• Great Western Hospital – Audiology (01793) 604200

• West Swindon Health Centre (01793) 889420

• National Deaf Children’s Society 0808 8008880Web address: www.n d cs. o r g . uk

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g

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Appendix 1

Audiogram

Name of child/young person:

……………………………………… Age:…………… Date of

audiogram:………………………… Type of hearing aid(s):

……………………………………….

HearingLoss in dB

-10dB

0dB

10dB

20dB

30dB

40dB

50dB

60dB

70dB

80dB

90dB

100dB

ZV

J mdb nng el u

kph g

i a r cho sh

f th s

110dB125 250 500 1000 2000 4000 8000

Frequency in Hertz

This graph can be copied and used to plot a child’s hearing loss against. By doing this we can see the sounds of speech they may be struggling to identify.

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Glue Ear Support Pack is available on the internet at www.swindon.gov.uk . It can be produced in a range of languages and formats (such as large print, Braille or other accessible formats) by contacting the Customer Services Department.

Tel: 01793 445500

Fax: 01793 463982

Email: customerservices@swindon.gov.uk