Using an app to manage glue ear in 2 to 8 year olds

The most common type of deafness in children is caused by otitis media with effusion (OME), also known as glue ear. Glue ear is caused by fluid or mucus building up behind the ear drum after a cough, cold or ear infection.

There are several ways this can be treated, but none are perfect.

• Behind-the-ear hearing aids are not always the best option because the condition fluctuates.
• Grommet operations often take place 1 to 2 years after the child first reports or has a diagnosis of hearing loss.
• Other options that could help, such as bone conduction hearing devices, cost up to £3,000.

The National Children’s Deaf Society estimates 1 in 5 pre-school children have glue ear at any one time and 8 out of 10 children will experience glue ear before the age of 10.

Situation

National Institute for Health and Care Excellence (NICE) guidance CG60 suggests that when a child is diagnosed with glue ear, they should have educational and behavioural support strategies to minimise the impact of hearing loss. Their family should also be signposted to further resources and information.

Many children are unsupported during the ‘watchful waiting period’ of glue ear management.

Patient groups reported that families felt disempowered to help their children between appointments. In some cases, children fell behind at school or with their speech and language development.

In many cases, glue ear fluctuates causing families to leave and rejoin a service many times.

Aspiration

After a diagnosis of glue ear, the team wanted to provide tools for families to support their child’s:

• hearing
• listening
• speech
• language
• auditory processing
• development

Solution

A team in Cambridge identified the need to support children with glue ear and started a project to address the gap.

The team designed the free Hear Glue Ear app which delivers glue ear information, advice, books, songs and listening games in a format that children like and recognise. There is also a hearing game to help parents gauge their child’s hearing loss at home (with either a tone or a speech discrimination test).

The app is designed to take into consideration children with additional learning needs, particularly children with Down's Syndrome.

The app encourages self-management of glue ear at home for children who:

• do not reach the threshold for a grommet operation or a hearing aid
• do reach the threshold and are waiting for the intervention

Impact

Glue ear causes hearing loss most commonly in children under 6, which is a critical time in development.

Research shows that using the Hear Glue Ear app alongside affordable bone conduction headphones successfully supports a child’s hearing and learning remotely. This takes place whilst either their OME is naturally resolving or they're waiting for an operation to insert a grommet.

Functionality

• The app can be used on a mobile phone or tablet.
• It can assess the volume levels in a room and recommend moving somewhere quieter if it’s too noisy
• Parents can understand how easily their child can hear speech with single-word speech tests. The child listens to a word at different volumes and presses the correct picture. This helps parents understand if their child cannot hear certain words.
• The app can be used with bone conduction headphones which have been shown to help children with glue ear.
• Speech and language therapists can also upload and deliver individual recorded sessions to a particular child’s app if needed.

Capabilities

The app can:

• test hearing using speech, a sound or tone.
• provide useful information from the National Deaf Children’s Society and the NHS website
• empowers parents to get a better understanding of their child's potential condition
• help parents seek advice and information while children can access tools, games and exercises within the same app
• provide speech language enrichment
• develop a child’s hearing through games
• help estimate a child's hearing between appointments
• be used to manage 2 or more children separately

Scope

The app is:

• used at home
• for all children diagnosed with glue ear, whether a hearing aid or further surgery has been recommended or not
• used alongside proper investigation and diagnosis by patients with suspected glue ear

Key learning points

• Be realistic about the challenges and opportunities associated with developing an app. The team had charity funding to start the project and had to write numerous funding applications to keep it free.
• The multidisciplinary team engaged various stakeholders to help build and test the app.
• The main barrier was that no one had recommended an app in health care before.

Building trust in the app was key. To reassure people about the app and increase trust, the team:

• underwent several medical reviews
• reviewed safety processes
• won numerous awards at healthcare events

Yet the clinical audience were still nervous to use it within their practice. To solve this, the team led a session on the importance of digital health and undertaking surveys to understand and address nervousness.

Key quotes

“I am pleased to see the app has been trialled with children with Down's Syndrome since they are so prone to glue ear.”

Dr Humphreys, Community Paediatrician Lead for Community Audiology, Cambridge

Find out more

Case study on improvements to speech discrimination using bone conduction headphones

Hear Glue Ear app and headset case study in the British Medical Journal

Case study on bone conduction hearing kit for children with glue ear

Key contact

Dr Tamsin Holland Brown, Paediatrician, Cambridgeshire Community Services NHS Trust

tamsin.brown1@nhs.net