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A Novel Approach to the Remote Management of Glue Ear

A bone conduction (BC) headset and microphone kit combined with a free phone app has proved to be an effective approach to remotely manage children with glue ear (otitis media with effusion [OME]), the results of a new study suggest.

During the first wave of the 2020 COVID-19 pandemic, children’s audiology services and grommet operations were stopped. In an effort to provide continuing care remotely, researchers in Cambridge invited children with OME (hearing worse than 25 dB at two or more frequencies in at least one ear) and those on the local grommet operation list to enrol in a single arm, prospective study assessing the use of a BC headset and Bluetooth microphone (the kit) combined with the Hear Glue Ear app, which is freely available on Apple and Android.

Twenty-six children aged between three and 11 years were enrolled, representing 82 per cent of children on the local grommet operation list. It was not possible to recruit a control group as there standard care was suspended during the pandemic.

Participants were posted the kit for use at home and school with instructions for the headset and details of the Hear Glue Ear app.

Before lockdown in March 2020, the average (mean) hearing loss in the group was mild, with hearing loss at frequencies of 0.5, 1, 2 and 4 kHz ranging from 0-65 dB.

In the three months before the kit was supplied, 19 out of 26 parents reported their child’s hearing as poor or very poor. With the kit, no parents reported hearing as poor or very poor and 24 out of 26 reported it as normal or slightly below normal.

Before the intervention, 23 out of 26 parents reported that the child often or always had difficulty hearing in a group compared with 22 of 26 saying their child rarely or never had problems hearing in a group when using the kit.

All families chose to keep the kit at the end of the study, even if the child’s hearing improved, often fearing glue ear may return. Three families said they would continue to use the kit rather than have a grommet operation.

Three children’s glue ear fully resolved while they were using the kit.

The majority of families found the remote management strategy acceptable and thought their child had benefited, helping them to hear better at home and school, and in some cases, improved their pronunciation, behaviour and listening anxiety.

The authors said remote management of glue ear in this way has many advantages: improving children’s hearing at an important stage of their development; preventing sequelae of hearing loss; preserving face-to-face hospital appointments for those needing them most; reducing travel to clinics with small children; empowering parents/carers to support their children; enabling children to hear online learning more clearly; and enabling children to hear when face masks obscure lip reading, as well as providing cost savings for the NHS and reducing the number of grommet operations.

"Innovative use of bone conduction headphones, a microphone and the Hear Glue Ear app, sent through the post to patients, is a novel, new and effective approach to the management of glue ear and its resulting hearing loss, especially when families have reduced access to audiology or Ear Nose and Throat (ENT) services, such as during the COVID-19 pandemic," the authors write.

A BC headset and microphone kit is expected to be widely available at the end of 2021 for about £55.

Brown TMH, O’Connor IF, Bewick J, Morley C. Bone conduction hearing kit for children with glue ear. BMJ Innov. 2021 Oct 4 [Epub ahead of print]. doi: 10.1136/bmjinnov-2021-000676.