Nasal balloon therapy helps fluid buildup in middle ear common to kids

TORONTO – A cheap and simple procedure that seems more like a party trick than a medical therapy appears to help young children clear their ears of fluid, a condition sometimes called glue ear.

British researchers reported Monday that having affected children inflate a balloon by blowing air through their nostrils helped rid the middle ear of fluid and re-establish its proper air pressure.

Though not all benefited from the procedure, nearly 40 per cent more of the children who used the technique had fluid-free ears at three months when compared to children who didn’t use the nasal balloon therapy, the researchers reported in the Canadian Medical Association Journal.

The authors said the technique could reduce the needless prescribing of antibiotics for this problem. Studies have shown antibiotics are ineffective against this problem, but doctors often prescribe them anyway.

Lead author Dr. Ian Williamson said wider use of the technique might also reduce the need for surgeries to insert drainage tubes in the ears of affected children.

“It works early on and some children are benefiting,” said Williamson, a family physician and associate professor of primary care at the University of Southampton in Britain.

“Surgery is great. But here’s a medical intervention that also works.”

The authors of the study have produced a video to demonstrate the procedure. It can be viewed on YouTube at https://youtu.be/Bwh5IyN26Fk.

The term glue ear may not be familiar to Canadians. The proper name for the condition is otitis media with effusion, though it can also be referred to as middle ear fluid.

The condition arises when the eustachian tubes malfunction. These tubes, which connect the ears to the back of the throat, drain fluid from the ears and maintain air pressure balance in the ears.

But in small children, the tubes often become blocked. That can result in a buildup of very thick fluid in the middle ears. And that can lead to hearing difficulties and speech problems.

In most children the problem resolves itself over time, said Dr. Johnna MacCormick, an ear, nose and throat specialist at the Children’s Hospital of Eastern Ontario in Ottawa. But some need to have tubes inserted into their ears to drain the fluid.

MacCormick said the study showed the technique is effective for some children and should be one of the options doctors explore.

“It did seem like it helped them clear fluid faster,” said MacCormick. “It’s certainly something to be considered.”

A specially designed balloon is stretched and then fitted onto one end of a nozzle. The child is then instructed to press one nostril closed with a finger and inflate the balloon by blowing through the nozzle with the other nostril.

“That pressure that you generate in the nose is sufficient to open up the tube that isn’t really opening properly,” Williamson explained. “It forces air into the middle ear. Then the fluid can drain out of it.”

The procedure is done three times a day for a month. If the problem hasn’t resolved at that point, daily treatment is recommended for another two months.

Dr. Adrian James, an ear, nose and throat specialist at Toronto’s Hospital for Sick Children, said use of the procedure probably could help some children avoid the need for ear tubes.

“Although … the study hasn’t shown that it would reduce the need for surgery, if it did a lot of families would be happy for that outcome,” said James.

Neither James nor MacCormick was involved in the research.

Nasal balloon autoinflation — the proper name for the technique — may not be common practice in Canada at this point.

MacCormick said doctors at CHEO employ a similar technique using a device called the Ear Popper. But it costs close to US$200 online, where the nasal balloon kit costs around US$20.

James said doctors at Sick Kids Hospital have used the nasal balloon kits — sold by a company called Otovent — in the past but have had trouble buying them locally more recently.