'Glue ear' treatment could see 'end to grommet surgery'

Silicone plug in the ear of a child with glue ear Researchers relieved the symptoms of persistent ear inflammation in mice

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Scientists have identified a potential new treatment for "glue ear" - a common hearing disorder in children - that uses existing cancer drugs.

Writing in PLoS Genetics, researchers from the Medical Research Council found that these drugs relieved the symptoms of persistent ear inflammation in mice.

They say the discovery could lead to an alternative to grommet surgery for many children.

A hearing loss charity said it was an important step towards a new treatment.

The study says that several existing drugs currently used in cancer treatment, known as VEGF inhibitors, can tackle the root causes of 'glue ear'.

Prof Steve Brown, director of the MRC mammalian genetics unit at the Medical Research Council and lead study researcher, said that a lack of oxygen reaching the middle ear was a key factor in the development of the condition.

GENEVIEVE'S STORY

Unbeknown to her parents, Genevieve Albooye had learnt to lip read as a toddler.

Constant ear infections had left her with chronic glue ear, affecting her hearing and speech.

She had operations to install grommets at three and four-and-a-half years old which helped restore her hearing by allowing air to circulate in the middle ear.

She was tested continuously until the age of nine. Doctors found no more problems.

Then, six weeks ago at the age of 12, Genevieve realised she couldn't hear the teacher properly and was getting confused at school.

Her mum, Jane, realised it had probably been going on for months.

Genevieve was regularly watching TV at top volume and friends were frustrated trying to communicate with her.

"Genevieve was always told she was a dreamer and some people started calling her 'random' because she would say odd things at odd times, simply because she didn't always hear conversations going on around her."

Their GP tried to tell them wax was the cause, but they sought specialist advice and got her booked in for another grommet operation.

"The effect was immediate. She woke up saying, 'why are you all shouting?'"

"This lack of oxygen, known as hypoxia, appears to prevent the inflammation in the middle ear resolving, allowing fluid to build up, which can impair hearing.

"By using existing drugs that tackle the root causes of hypoxia, we have been able to significantly reduce hearing loss and the build-up of fluid in the middle ear of our mouse models."

Non-invasive

The researchers say they want to "repurpose" the cancer drugs into a treatment which can be delivered directly into the ear at the area of inflammation.

They claim this will help to eliminate any potential side-effects of the drugs.

"The next stage involves looking in more detail at how to apply this in humans and children," Professor Brown said.

"We wouldn't normally want to give anti-cancer drugs to children, but the middle ear is relatively accessible and a GP could put a patch directly on the membrane in the middle ear."

He also said it would be a non-invasive, non-surgical treatment.

Currently, NICE recommends grommets or hearing aids as effective treatments for glue ear which does not clear up over time.

Grommets are tiny plastic tubes which are put into the eardrum to improve ventilation during a short operation under general anaesthetic.

Around 30,000 grommet insertions are carried out each year in the UK.

'Ground-breaking'

Dr Ian Williamson, senior lecturer in general practice at the University of Southampton, expert in the field of otitis media and adviser to Deafness Research UK, said the study was a considerable scientific advance.

"By developing genetic disease models for glue ear, the research team have gained new insights into potential ways of identifying children at risk.

GLUE EAR FACTS

  • Glue ear is the common term for the medical condition otitis media with effusion.
  • It is one of the most common childhood illnesses.
  • Children under the age of five are most often affected.
  • It is often linked with ear infections.
  • Colds and flu, allergies and passive smoking can also contribute to glue ear.
  • Glue ear will often clear up on its own after congestion has gone.
  • But if it continues, it can cause temporary deafness, delayed speech development and affect behaviour.

Source: NDCS

"Although the results published today are clearly ground-breaking, carefully controlled clinical trials would be needed before any new treatments would be available in the clinic or doctors surgery."

Vicki Kirwin, audiologist with the National Deaf Children's Society, said they also welcomed the research.

"This research is at a very early stage, but we welcome all medical discoveries which contribute to a greater and more positive understanding of deafness and which will give families more choice in support and treatment.

"Eight out of 10 children will have experienced glue ear at least once before they reach the age of 10. Although it's a common condition, it can have a big impact.

"If a child has glue ear for a long time, it can affect their speech and language development, they may fall behind at school and can even become disruptive if they don't get extra support."

Dr Ralph Holme, head of biomedical research at Action on Hearing Loss, said: "This research is an important step towards an effective pharmacological treatment for this common and distressing condition."

The research was carried out by the MRC Mammalian Genetics Unit, the Mary Lyon Centre at Harwell and the University of Oxford.

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