DS has very mild hearing loss prob due to glue ear - what next?

[BirdyBedtime]

DS (3.5) has been followed up hearing-wise since birth due to having meningitis and although he passed a hearing test at 1.5 the last 2 he's failed on one ear (different each time). We were there again yesterday and he failed in both ears - just above the line, so very mild loss - and when they measured his eardrum there was congestion. The audiologist wants to see him again in 3 months but said that if he is still congested he'll be referred to ENT and she mentioned grommets.

I'm a bit unsure about all of this as have no experience or friends with this. I thought that grommets were for when they'd had lots of ear infections, but DS hasn't had any at all, although he does get really bad colds and coughs. I don't think the hearing loss is of a level to be concerned about as if he hadn't been being followed up I certainly wouldn't have been concerned enough to take him to the docs - he does say 'pardon' a lot when he has a cold, but not so much at other times apart from when there is a lot of background noise eg traffic. His speech is fine for his age and clear enough. and nursery have not noticed any problems with listening etc.

I'm just wondering whether I should be worrying about this (as I am a worrier!) or just wait until we see the audiologist again. I really don't like the idea of surgery unless it's really really necessary.

Hi there Birdy. My son is going to have an operation to have Grommets fitted in two weeks, he has just turned two. There really is nothing to worry about, it is quite a straightforward procedure that will help him considerably with his hearing. It is likely he has reduced hearing in that one ear which means he will struggle to hear what is being asked of him, struggle to hear tv/radio etc. I identified the problem with my son when his speech was delayed and unclear. he has glue ear in both ears and needs the op to ensure he develops normal speech. For a slightly older child I have been told that failure to clear the ears can lead to poor behaviour in school as children struggle to hear and often 'switch off' in class. They will be doing another check before referring him as some children can get better on their own, but if its still there over time it is likely he will need the op - hope that helps a bit!

I was just about to post something similar Birdy! My DS(3y10m) has been tested 4 times now with mild glue ear one side and hearing has tested fine the last two times. The audiologist was saying we could either keep testing every 6m as we have been or send him to an ENT paed. I agreed to the first but she kept saying if I wanted him to see ENT I could.
I'm just confused because if his hearing is fine and he's never had an earache or any symptoms in his life, what exactly is the problem? He was tested due to language delay but that is now likely to be part of a pervasive development disorder anyway and is improving. I'm loathe to visit any more clinics than necessary because he can be so unco-operative.

Thanks littlemiss . I hadn't thought about it affecting behaviour but can see now how it could. DS is going to be one of the youngest in his year at school (and pre-school from August) so is going to need all the help he can get, including hearing properly. I suppose I just thought that glue ear/grommets were always to do with ear infections which he hasn't had.

I hope your DS's op goes well and it helps him.

Thinking about it although his vocabulary is very good his speech can sometimes be unclear so maybe it has been a problem that we've just not been particularly aware of (we've been busy focussing on the lazy eye/glasses issue poor thing).

If I was you silkstalkings I'd just continue monitoring with the audiologist for now if his hearing is OK. Like you say you don't want to go down a route that isn't really necessary particularly if he isn't keen on clinics. My DS unfortunately is so used to being poked and prodded due to various things that he just seems to take it all in his stride.

I think it could be more of a problem when he starts school than it has been in nursery; for a lot of children their glue ear is only picked up when they start school because they've been managing fine in a home/nursery environment and it's only with the additional pressure that school puts on their hearing that the fact that there is a problem becomes clear.

You're quite lucky to be ahead of the curve in that it's been picked up now, so that if it doesn't resolve itself (and bear in mind that the overwhelming majority of the time it does resolve within three months without intervention, so the chances are it will for your DS) he will already be in the system and queued up for grommets at a point where his classmates are only just being diagnosed.

SilkStalkings, an ENT paed can refer for further diagnostic tests where an audiologist usually can't, which may be why the audiologist was pushing that option. But if you are already getting diagnostic referrals down another route for his language delay and are already accessing support services like SLT then I agree with you that the ENT referral seems unnecessary (and if you're seeing Audiology every 6 months anyway you could always change your mind further down the line if circumstances change).

(And, yes, recurrent colds can easily cause glue ear as they lead to fluid buildup in the middle ear with the tubes that should drain it blocked up. DD2 is gluey at the moment after a string of spring colds)

This leaflet Guide to Glue Ear will give you some more information

As others have said it is possible to have glue ear with out infections, or in our case speech delay, as with any condition or impairment it displays in different ways. ds1's glue was only picked up when he started School and it took us a year to get grommets, the difference was amazing. We then had ds2 and ds3 checked and they both too have had grommets - each has reacted differently to impaired hearing. ds3 is the only one who's needed SALT at this time. ds2 has had to have 2 sets in less than a year and also has enlarged tonsils and andenoids, he's been snotty and snoring since birth.

My advice is whatever you decide to do make sure School and/or Nursery know that this is a concern - words like 'temporary' 'will grow out of it' 'mild hearing loss' aren't helpful to a child with impairment in a School setting (20db hearing loss - just below 'normal' hearing - is the same as walking around with your fingers in your ears) ds1 had significant loss and still has high frequency loss which impairs his ability to distinguish between the 'ch' 'f' 'th' sounds - fine for speech, hard going for learning phonics, learning to read and spelling in infants.

Hearing aids could be an option if you want to avoid surgery. Others have suggested dairy free (we're trying this) or cranial oesopathy (on my list when I've saved some money for it)

We chose to go for grommets due to social and behavioural impact to ds1 in School - you are not at this stage yet I guess. Rarely long term glue ear can lead to middle ear and ear drum damage - we have family history of glue ear (dh had sets as a child) so decided to opt for surgery. Even if you get referred to ENt you don't have to have grommets it might be a chance to ask them lots of questions and be monitored by a specialist, it shouldn't be a given that they will only recommend surgery.

This maybe a useful reference NICE guidelines for management of glue ear

Thanks so much Casey and incy - that's really useful and the point about walking about with fingers in ears is really good - if the db scale is exponential (which I think I remember from school in the mists of time) then what looks like a little difference on the chart could actually make a big difference practically. Anyway, I've left a note at nursery explaining the issue and what they can do to help. Will also mention it when we go for his induction visit for school nursery in a few weeks.

If he's going to be prone to fluid build up (which I suspect he is as he's had congestion of one sort or another at 3 appointments over 3 years) I suppose we'll just have to get used to it and will be back and forth to audiology, ENT etc. Interestingly when I was telling the nursery carer this morning another mum who was dropping off said 'oh yes, DS is also on a 3 month wait for repeat assessment' so it's obviously fairly common. I certainly want to do what I can to make sure he's not disadvantaged when starting school (as I mentioned he's going to be nearly the youngest in the year as it is) so if grommets it must be then so be it. I don't think hearing aids would be something I'd be keen on tbh as he already wears glasses and that's enough of a physical thing to be dealing with.

There'd be a practical difficulty, as well, because it would be a behind-the-ear aid and it would get in the way of the arms of the glasses (obviously there are ways around that if necessary, but if not necessary it's an extra faff). DD2 has to have an aid when we're in a 3-month wait for reassessment (like now) and they are blinking annoying.