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What are the new findings?
Cheap alternatives to hearing aids can be used for children with glue ear.
Care for glue ear can be delivered remotely.
The kit (Bone conduction (BC) headphones, microphone and Hear Glue Ear app) is acceptable to children and their families.
How might it impact on healthcare in the future?
Further clinical trials could evidence cost-effectiveness and clinical effectiveness of the solution.
Grommets may be able to be avoided in many cases of glue ear.
Mild, fluctuating cases of glue ear could be offered early hearing support.
Schools may need further sensory support training to assist children in the classroom situation.
Hearing loss is one of the most common disabilities in childhood.1 One in 10 children starting school in UK or Europe have hearing loss secondary to glue ear (Otitis Media with Effusion (OME)).1 2 This is much higher in lower income countries. Eighty per cent of children have at least one episode of glue ear, where fluid builds up behind their eardrum after a cough, cold or ear infection. OME often self-resolves or children can be offered grommets (also known as ‘tympanostomy tubes’) if persistent.3
Grommets ‘only offer short term hearing improvement’4 of ~12 dB, diminishing to ~4 dB 6–9 months later,4 therefore grommets improve a child’s symptoms for about 6 months while ‘natural resolution continues’.3 Grommet insertion is common, requiring a general anaesthetic, and risks include opening the middle ear to infection (requiring treatment in approximately a third of patients), perforation (1% of cases) and variable scarring the eardrum (tympanosclerosis).
Hearing aids are not an easy solution, since glue ear fluctuates and multiple audiology appointments are needed to avoid overamplification or underamplification.
Children need to hear to learn. Poor hearing can affect speech, language, social skills, listening, attention and learning. While some children catch up learning after an episode of glue ear, others do not. Glue …
Collaborators Expert Otolaryngology and Audiology Collaborators: Josephine Marriage, Roger Gray.
Contributors TMHB: conceptualisation, data curation, seeking donation of equipment for study, methodology, investigation, visualisation, writing original draft, review and editing, literature search, figures, study design, data collection, data analysis, data interpretation, writing. IFO’C: methodology, recruitment, investigation, manuscript study design, review of drafts and editing. JB: methodology, recruitment, data curation, manuscript study design, data interpretation, helped verify underlying data, review and editing of drafts. CM: conceptualisation, data curation, supervision, verified underlying data, manuscript figures, data analysis, data interpretation, writing, review and extensive editing.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests TMHB helped create the free, charity-funded Hear Glue Ear app that was used in this study. TMHB conceptualised the use of the bone conduction headphones and microphone.
Provenance and peer review Not commissioned; internally peer reviewed.
Press Release Simple affordable headphones and app helped children with hearing loss from 'glue ear' to hear while hearing services and grommet operations were unavailable during the COVID pandemic. Glue ear is a common condition where fluid builds up behind the ear drum, often leaving childen partially deaf. Grommet operations consist of draining the fluid and placing a small, temporary tube across the ear drum to aerate the middle ear to help sound transfer. During the pandemic this group of children couldn't access interventions such as grommet surgery and were experiencing additional listening challenges with face masks obscuring lip reading, social distancing making it harder to hear, and education moving on-line. Paediatrician, Dr Tamsin Holland Brown from Cambridge Community Services NHS Trust collaborated with surgical colleagues from Cambridge University Hospitals NHS Foundation Trust as well as the well known computer company Rasperry Pi to quickly set up a research project to offer headphones, a microphone and Hear Glue Ear app for patients at home who needed simple hearing support. The kit was sent through the post to families who set it up at home for their child using written or video instructions. Children were then followed up with video consultation. The study went better than expected, with families able to set up the kit and many children finding the headset helpful: more than half choosing to take the headset to school with them as the schools reopened. Over the course of the study some of the glue ear cases slowly self resolved and which meant some of the children no longer needed the grommet surgery. Some NHS services are now considering adopting this approach to deal with the extending waiting lists during the COVID recovery period.
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