Health: It's a miserable life when the volume's turned down: Researchers hope to find alternatives to surgery for treating severe glue ear in children, writes Christopher Mowbray

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Indy Lifestyle Online
Whenever Anika Higgins catches one of the frequent colds that make her life a misery, her brother, her two sisters and her parents are forced to endure an overdose of Noddy, Big Ears and Mr Plod the Policeman.

As soon as she starts to sniff, she begins to suffer excruciating earache and becomes partially deaf. This means that the volume of the television has to be turned up so she can hear her favourite programme. Her home at Portishead, near Bristol, reverberates with the adventures of Toytown.

Anika, aged five, is one of millions of children affected by 'glue ear', that most political of childhood afflictions which became a cause celebre during the last general election campaign in the 'battle of Jennifer's ear'.

Anika's mother, Nicola Higgins, says: 'Anika is living in a muffled world. Because she cannot hear us talking properly, it has affected her own speech and she has a lisp. She is not a noisy child, yet she often shouts because she cannot hear herself properly. At other times you might think she is naughty because she does not appear to listen.'

Glue ear is a condition in which fluid accumulates in the middle ear when the mucus-secreting lining of the cavity becomes overactive and produces large amounts of a sticky fluid. Bacteria accumulate. When the fluid also blocks the Eustachian tube linking the middle ear to the throat at the back of the nose, the fluid cannot drain away.

All this affects the ability of the eardrum to vibrate and causes deafness and pain. But the underlying causes of this miserable condition are not well understood.

It is estimated that two-thirds of all British children suffer spasmodically from glue ear. In 10 per cent of cases, the complaint develops into a chronic condition known as otitis media with effusion (OME). In mild cases decongestant nose drops can clear the Eustachian tube, but in more severe cases surgery under general anaesthetic is necessary.

The operation is called a myringotomy, during which the eardrum is pierced and a small tube - or grommet - is inserted to allow the middle ear to drain.

Grommet insertion is the most common surgical operation under general anaesthetic for children in Britain, and is thought to cost the National Health Service between pounds 100m and pounds 200m every year.

And research in the United States indicates that, long-term, OME can cause a small but significant drop in children's intelligence ratings.

Since neither missing school nor surgery is desirable for young children,

researchers are trying to find new ways of treating glue ear. At the University of Birmingham work will start next year which concentrates on the immune

system.

When the Birmingham team of scientists was trying to find out why 10 per cent of meningitis sufferers become deaf, in a project supported by the Meningitis Trust, it discovered a chain of events that began with the way in which the body's immune system responded to infection.

As a result the Hearing Research Trust, a charity, is trying to raise pounds 95,000 to fund the new research into glue ear.

Dr Michael Tarlow, senior lecturer in paediatric infectious diseases at Birmingham, believes glue ear particularly affects children because their immune systems are immature and because they are more likely to get infections.

He says: 'We don't yet know if glue ear results from an overreaction of the immune system, but this is one of the things we are trying to find out. Once we understand what is happening we believe it might eventually be possible to damp down these bodily responses to bacteria with existing medicines or with ones being developed. We also hope our research will save an enormous amount of public money.'

Dr Tarlow explains that when infection occurs and bacteria die or are killed by antibiotics, a substance called endotoxin is released from the outer skin of the bacterial cells. 'This toxin sticks to white blood cells and triggers them into activity as part of the immune response. They start pouring out other chemicals called cytokines, which help the body to resist bacteria.

'They pull more white blood cells into the infected area, producing what we know as inflammation. We think the inflammation is not so much caused directly by the bacteria but by the response to them of white cells, and we need to find out more about the cytokines.

'All this activity causes an increase in fluid in the infected area. The capillaries (tiny blood vessels) leak out not blood but fluid, in which the blood cells swim. This is what is happening in the cavity of the middle ear.'

Dr Tarlow adds: 'Some children spend years with fluid in their ears. Others may not get near ear, nose and throat surgeons because the complaint is never diagnosed. If children suffer from impaired hearing like this during their formative years, it delays their development.'

Dr Tarlow also thinks the research could have wider implications for fighting life-threatening infections, which can cause death from septic shock when the immune system is overwhelmed and antibiotics fail.

'We have wonderful antibiotics now, which we can just wave about and kill off bacteria - but still children are dying of infection,' he says. 'We have spent 60 years looking at bacteria and viruses, and we have got as far as we can in that direction. It is perhaps time for us to change course.'

While Anika Higgins waits to go into hospital to have grommets inserted in both her eardrums, the high decibel reading from the family television continues. Her mother is only too familiar with this ordeal: Anika's brother, Oliver, now 14, suffered identical symptoms and had to have grommets in both his eardrums when he was six.

Mrs Higgins recalls: 'When my son came round after the operation, the first thing he did was tell me to stop shouting, because he was not used to hearing normal speech. Previously, he had always sat quietly by himself and played on his own, and everyone said what a good boy he was. But I realised it was not natural because he used to have blank spells, as if he were daydreaming.

'After the operation, he became very interested in everything around him and his schoolwork improved immeasurably. He had extra tuition to help him to catch up with his classmates in English and reading.

'Anika followed the same pattern of illness when she started attending a nursery school a year ago and came into contact with other children suffering from colds. She was soon catching, on average, two colds a month.'

These, Mrs Higgins says, led to earache and miserable, sleepless nights for Anika and her parents. Anika cries with the pain. 'We feel so helpless because there is little we can do except comfort her.'

Mrs Higgins says: 'If she is left to her own devices, she will play happily by herself in her own little shell, and that is not natural. It also affects her sense of balance and she often appears to be clumsy because she keeps falling over.

'You can understand why teachers sometimes think children with this complaint are not paying attention or are a bit dull.'

(Photograph omitted)

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