Treatments for glue ear Our leaflet Glue ear provides information about glue ear and grommets. For a copy of this leaflet, phone our Freephone Helpline on 0808 800 8880 (voice and text). This factsheet gives you information on preventing, and treatments (other than grommets) for, glue ear. Glue ear happens when the middle ear fills with mucus and fluid. This can cause temporary deafness. Most treatments, including those mentioned in this factsheet, concentrate on the following. Improving the function of the eustachian tube (the tube that runs from the middle ear to the back of the throat), allowing air to circulate up to the middle ear. Preventing infection and the build-up of mucus that can cause glue ear. In 2008, the National Institute of Clinical Excellence (NICE) published guidance about glue ear for the NHS in England, Wales and Northern Ireland. Having studied all the research evidence currently available they made recommendations on the use of various treatments for glue ear. Their recommendations are based on the treatments that effectively treat glue ear for the greatest numbers of children who have the treatment. For some treatments there may be very little or poor quality evidence available that has been documented. This might be because it is still quite a new treatment. Alternatively the treatment may be offered by the alternative or complementary health sector who do not tend to produce the type of scientific research evidence reviewed by NICE. Because parents frequently contact us to ask about alternative or complementary treatments for glue ear we have written this factsheet. Some of the treatments may help some children and parents may like to consider trying them. The factsheet is divided into preventative measures, treatments that NICE found effective, treatments not found to be effective or lacked sufficient evidence to advise and treatments not mentioned in the guidance. Preventative measures were not evaluated by NICE. A copy of the patient information NICE guidance can be downloaded from www.nice.org.uk. It is a good idea to discuss the various options with your family doctor (GP) or ear, nose and throat (ENT) consultant. NDCS uses the word ‘deaf’ to refer to all levels of hearing loss.

Treatments for glue ear

Preventative measures Breastfeeding It is known that breast milk provides essential nutrients to help children to fight off infections in the first few months of their life. Breastfeeding also passes on the mother’s natural protection against illness. Research has shown that children who have been breastfed from birth are less likely to get glue ear at a young age. Ask your GP or health visitor for more information about this. It may help to feed your baby (either breastfeeding or with a bottle) in a sitting position rather than lying flat. This helps prevent fluids entering the eustachian tube during feeding. Smoke-free environment Research carried out by the Department of Health has shown that all children are more likely to get ear infections and glue ear if they are often in a smoky environment. A child is likely to experience glue ear for as long as the environment remains smoky. Parents should try to make their children’s environment smoke-free. The environment includes the home, car, crèche, playgroup or school. If it is not possible to make the environment entirely smoke-free, then smoking should be confined to an area not used much by children. It is important to remember that simply opening a window is not enough, as many dangerous smoke particles will stay in the air.

Treatments that NICE found effective Grommet surgery Grommets are tiny plastic tubes that are put in the eardrum. This is done during a short operation in hospital under general anaesthetic. The grommets are inserted after the fluid in the middle ear has been drained away. The grommets allow air to circulate in the middle ear and stop more fluid from building up. For more information about grommets read the NDCS leaflet ‘Glue ear’. Hearing aids Hearing aids can also be offered to children as an alternative to surgical treatment. For more information about hearing aids read the NDCS booklet ‘Hearing aids: A guide for families’. Autoinflation and the Otovent treatment Autoinflation may be helpful for some older children during the watchful waiting period or whilst waiting for grommet surgery.

For more information telephone the Freephone Helpline on 0808 800 8880 (voice and text). NDCS is a registered charity in England and Wales no. 1016532 and in Scotland no. SC040779

Treatments for glue ear

Autoinflation is a method of encouraging the eustachian tube (the tube that runs from the middle ear to the back of the throat) to open. This can help drain the ear naturally through the eustachian tube, by forcing air from the back of the throat to the middle ear. With older children, you can try this by holding your child's nose and getting them to swallow at the same time. You may have to do this a couple of times. Ask your GP for more details. Otovent is a device made up of a balloon and a nosepiece. This treatment involves fitting the balloon to the nosepiece, putting the nosepiece against one nostril and keeping the other nostril and mouth closed. The child then blows into the balloon through the nostril then releases the air back into the nose, swallowing at the same time. Otovents are now available on prescription. Ask your GP about whether they think it will be suitable for your child.

Treatments that NICE found ineffective or lacked sufficient evidence to advise Diet It is believed that your child’s diet can affect the amount of mucus their body produces. Dairy products (made from cow’s milk) and a high amount of sugar in a child's diet can increase the amount of mucus the body makes. A build up of mucus may be a cause of glue ear. It is important that a child has a balanced diet. If you think it may help to reduce the amount of cow’s milk in your child’s diet, but you are worried about your child lacking calcium, consider alternatives such as broccoli, which are naturally high in calcium and calcium enriched dairy alternative products. Always ask your GP for advice before changing your child’s diet. Eating more healthy food with plenty of fresh fruit and vegetables, grains and lean meat or fish may also help. You can also ask to see a registered dietician. Homeopathy Homeopathy is a type of care used to treat a wide range of conditions, including glue ear. It may help to stimulate the body’s own immune system by using tiny doses of natural substances. It is often used to complement other forms of healthcare. For more information, contact the British Homeopathic Association at: Hahnemann House 29 Park Street West Luton LU1 3BE. Phone: 01582 408675 (voice) Fax: 01582 723032 Email: [email protected] Website: www.britishhomeopathic.org All doctors who are listed practioners with the British Homeopathic Association are registered with the General Medical Council and have undertaken training in homeopathy at a faculty- accredited postgraduate teaching centre. For more information telephone the Freephone Helpline on 0808 800 8880 (voice and text). NDCS is a registered charity in England and Wales no. 1016532 and in Scotland no. SC040779

Treatments for glue ear

Osteopathy Osteopathy is a system of diagnosing and treating conditions, concentrating on the body's structure. This treatment can help to realign muscle tissue, bones and joints, allowing the body to function effectively and in doing so, may relieve pain and ailments. For information about osteopathy and to find a registered osteopath in your area contact the General Osteopathic Council. The General Osteopathic Council registers qualified osteopaths and sets standards of osteopathic practice and conduct. Their aims are to protect patients, to develop the osteopathic profession and promote an understanding of osteopathic care. Phone: 020 7357 6655 (voice) The line is open between 9am and 5pm, Monday to Friday Fax: 020 7357 0011 Website: www.osteopathy.org.uk The Osteopathic Centre for Children is a registered charity that offers osteopathic treatment to children up to the age of 18 for a wide range of conditions. The OCC has a centre in London. For more information contact: The Osteopathic Centre for Children (London) 22a Point Pleasant London SW18 1GG Phone: 0208 875 5290 (voice) The line is open between 9.30am and 5pm, Monday to Friday Fax: 0203 538 2578 Website: www.occ.uk.com

Treatments not mentioned by NICE Allergies Research suggests that allergy may be related to persistent glue ear in some children. You can ask your GP about testing your child for allergies or referral to an NHS allergy clinic if you think this might be the cause. Allergies to fur, pollen, dust mite or some foods may cause the eustachian tube to swell. This can prevent fluid from draining from the middle ear. For more information on allergy you may like to contact the charity Allergy UK. Their website is: www.allergyuk.org. Xylitol Xylitol is a plant-based product, which is usually used as a sweetener in food. It is lower in calories than sugar and can be used by diabetics. Xylitol has been shown to inhibit the type of bacteria that can be a cause of tooth decay and ear infections. Clinical trials have shown that xylitol-based chewing gum, when used regularly, may reduce ear infections and glue ear.

For more information telephone the Freephone Helpline on 0808 800 8880 (voice and text). NDCS is a registered charity in England and Wales no. 1016532 and in Scotland no. SC040779

Treatments for glue ear

In the UK, xylitol can be found in small amounts in some types of chewing gum, children's vitamins and toothpaste. Other xylitol products currently available in the United States include granules, nasal sprays and sweets. A nasal spray containing xylitol has been developed and is available from health food and vitamins and supplements suppliers. For more information, talk to your GP or ENT consultant. There is also a US website (www.xylitolworks.com) with more information. You can also email [email protected] for further information. For a copy of our leaflet Glue ear or information on any other issues relating to glue ear, such as education or communication, contact the NDCS Freephone Helpline on 0808 800 8880, email us at [email protected] or contact us via Live Chat at www.ndcs.org.uk/livechat. If you prefer to speak a language other than English, tell us the language of your choice and your phone number (in English). We will call you back with an interpreter within a few minutes. This information can be requested in large print, in Braille, and on audio CD. February 2008

For more information telephone the Freephone Helpline on 0808 800 8880 (voice and text). NDCS is a registered charity in England and Wales no. 1016532 and in Scotland no. SC040779