Glue Ear: Why Talking Can Stall After Colds
Written by the Inclusive Developmental and Therapy Center therapy team — our Speech & Language Therapist, psychology and ABA staff. Clinical reviewer for this site: Dr Muhammad Suffyan, MB BS (GMC 8023727) · Updated August 2026; this page has changed since our last clinical review.
Glue ear is fluid trapped behind the eardrum when there is no active infection. Doctors call it otitis media with effusion. To the child it feels like listening through a blanket, or as if they are underwater. To the parent it often looks like “he only hears when he wants to,” a toddler who stopped adding words after a winter of colds, or a school child who says “haan?” all day.
It is not the same as a painful ear infection. There may be no fever, no discharge, and no obvious ear-pulling. That is why it is missed, and why a child can spend months copying muffled speech.
How common is glue ear?
UK guidance used worldwide (NICE Clinical Knowledge Summaries) puts the numbers like this:
- It is most common between six months and four years.
- It is the most common cause of hearing impairment in childhood.
- More than half of children have an episode in the first year of life, and up to 80% by the age of four.
- When five- and six-year-olds are screened, one in eight have fluid in one or both ears that day.
- In children with Down syndrome or a cleft palate the figure is 60–85%.
A Cochrane review of grommets (PMID 37965944) adds the course: most episodes clear within three months, about 35% of children have more than one episode, and 5–10% of episodes last more than a year.
So a single blocked month after a cold is ordinary. Months of muffled hearing, especially in both ears, is not something to wait out with “he will grow out of it.”
How does glue ear change talking?
Children learn speech from what they hear. Quiet, high sounds — s, sh, f, t, k — are the first to vanish when the middle ear is full of fluid. Those are also the sounds that carry word endings in English and a lot of the clarity in Urdu. A child with glue ear may:
- drop endings — “ca” for cat, “bu” for bus
- mishear instructions unless they can see your face
- answer a different question from the one you asked
- turn the television up, or sit right in front of it
- look inattentive, dreamy, or “naughty” at school
- stall on new words after a run of coughs and colds
NICE guideline NG233 (2023) lists exactly this picture: hearing difficulties, delayed speech and language, ear discomfort, tinnitus — and also poor concentration, withdrawal, irritability, slow school progress, and clumsiness. Glue ear is a hearing problem that impersonates a behaviour or language problem.
That is why we ask about ears before we start a block of speech therapy. Treating unclear speech while the child is still listening through fluid is like teaching reading in the dark.
Glue ear, ear infection, or lasting hearing loss?
Three different things get mixed up in the same conversation:
- Acute otitis media — a painful infected ear, often with fever. That is a doctor’s job this week, not a speech question.
- Glue ear (OME) — fluid without infection. Hearing goes up and down. Most of it clears. Some of it does not.
- Sensorineural hearing loss — a problem in the inner ear or nerve, not the middle-ear space. That does not wait three months. Our page on conductive versus sensorineural hearing loss is the map.
Glue ear is a conductive problem: sound is not getting through the middle ear cleanly. A hearing aid or implant is a different pathway. Do not skip the hearing test because “he startles at the door.” Loud sounds still get through. Quiet speech does not.
What should we do this month?
Get hearing checked. In Multan that is usually an ENT doctor (kaan, naak, gale wale) plus a proper hearing test, not a glance in the ear in a busy OPD. Ask for the result in writing. If fluid is found, NICE’s first move is information and watchful waiting — not antibiotics, not decongestants, not oil in the ear.
Change how you talk at home while you wait. Get in front of your child before you speak. Cut background noise (the television, the fan if you can). Use a slightly slower, clearer voice, not a shout. Check what they understood, rather than asking “did you hear me?” Seat them away from the corridor at school. These are the same listening strategies NICE asks families to use while glue ear is being watched.
Do not start “speech drills” as the only plan. If talking has stalled, we can still assess language and show you how to keep conversation going — see hearing and speech and how hearing affects speech. The speech work changes once hearing is clear. It does not replace the ENT visit.
When are grommets (ventilation tubes) considered?
Grommets are tiny tubes placed in the eardrum so air can get into the middle ear and the fluid can drain. They are a surgical decision, not a therapy one. We do not insert them, and we will not talk you into them.
NICE NG233 (2023) says grommets may be considered for glue-ear hearing loss after specialist assessment, with a shared decision about benefits and risks (perforation, scarring, infection while the tube is in). NHS commissioning guidance still expects:
- audiology and ENT assessment, including a hearing test and tympanometry
- a reassessment about three months later, because so much glue ear clears on its own
- surgery discussed when hearing loss is still there and it is affecting listening, talking, behaviour or school
Children with Down syndrome or a cleft palate are not on the same “wait three months” clock. They need a specialist team earlier, because glue ear is the rule rather than the exception. Cleft and talking: cleft palate and speech. An open mouth and snoring belong on mouth breathing.
The evidence on language is honest rather than magical. Grommets improve hearing in the short term. Long-term speech scores are mixed. The point of the operation is months of usable hearing during the years a child is learning to talk — not a promise that words will catch up on their own.
What we do, and what we send you for
Inclusive Developmental and Therapy Center in Model Town, Multan is a speech, behaviour and learning clinic. We do not diagnose glue ear, we do not prescribe, and we do not operate. What we do is notice the pattern, send you for a hearing test, and then work on listening and talking once we know what the child can actually hear.
If the test is clear and speech is still behind, that is a different page: speech delay, unclear speech, or why a toddler is not talking. If the test shows fluid, the next adult in the room is an ENT doctor. Both can be true at once.
A consultation is Rs 1,500 and lasts up to 50 minutes. Bring any hearing report you already have. If you have none, we will still see the child — and we will still ask you to get the ears checked.
Frequently asked questions
Is glue ear the same as an ear infection?
No. An ear infection (acute otitis media) is usually painful and often comes with fever. Glue ear is fluid behind the eardrum without that infection. A child can have glue ear with no pain, no discharge and no obvious illness — which is why it is easy to miss and why talking can stall quietly after a winter of colds.
Will glue ear clear on its own?
Most episodes do, within about three months. NICE and the NHS treat watchful waiting as the first step, not antibiotics. What you should not wait out is months of muffled hearing in both ears, a child whose words have stalled, or a child with Down syndrome or a cleft palate — those need a specialist look sooner.
Can glue ear cause a speech delay?
It can contribute, because children copy the speech they hear, and glue ear muffles the quiet sounds that carry word endings. The association with long-term language delay is weak if hearing recovers. The practical risk is the months in the middle: a toddler who cannot hear “s” and “t” clearly will not practise them. Get hearing checked, then look at speech.
Does my child need grommets?
That is an ENT decision after a hearing test and, usually, a second look about three months later. Grommets are considered when glue ear is still affecting hearing and daily life. We do not insert them. We will tell you when the picture looks like a surgical conversation rather than a speech one.
Antibiotics, oils, or steam — do they clear glue ear?
NICE does not recommend medicines, decongestants or complementary treatments as a way to clear ordinary glue ear. Steam and oil in the ear are not a plan. If someone is selling a “kaan ka ilaj” that claims to drain fluid without a hearing test, walk away and book ENT.
Should we still start speech therapy while we wait for ENT?
You can start an assessment. We will not drill sounds the child cannot hear. We will show you how to talk so more of it gets through — face to face, less background noise, check understanding — and we will set speech targets once hearing is clearer. Waiting for a perfect audiogram before anyone looks at language is how families lose a term.
My child startles at loud sounds. Can they still have glue ear?
Yes. Loud bangs and the television still get through. Quiet speech, word endings and a teacher talking from the front of a noisy class do not. “He hears when he wants to” is the sentence glue ear earns. A hearing test answers it.