Bone conduction hearing kit for children with glue ear

© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Background Hearing loss is one of the most common disabilities in childhood. One in 10 children starting school in UK or Europe have hearing loss secondary to glue ear (Otitis Media with Effusion (OME)). 2 This is much higher in lower income countries. Eighty per cent of children have at least one episode of glue ear, where fluid builds up behind their eardrum after a cough, cold or ear infection. OME often selfresolves or children can be offered grommets (also known as ‘tympanostomy tubes’) if persistent. Grommets ‘only offer short term hearing improvement’ of ~12 dB, diminishing to ~4 dB 6–9 months later, therefore grommets improve a child’s symptoms for about 6 months while ‘natural resolution continues’. Grommet insertion is common, requiring a general anaesthetic, and risks include opening the middle ear to infection (requiring treatment in approximately a third of patients), perforation (1% of cases) and variable scarring the eardrum (tympanosclerosis). Hearing aids are not an easy solution, since glue ear fluctuates and multiple audiology appointments are needed to avoid overamplification or underamplification. Children need to hear to learn. Poor hearing can affect speech, language, social skills, listening, attention and learning. While some children catch up learning after an episode of glue ear, others do not. Glue ear mostly affects those under 8 years old, which is a critical time for development, speech acquisition, learning, writing, spelling and phonics. Deafness at this time interferes with speech development, language, communication, auditory processing, selfesteem, socialisation, listening and learning. Operational aims and objectives Bone conduction hearing aids work well in OME because they send sound as a vibration through the bones of the skull directly to the cochlea (bypassing the eardrum and middle ear bones where the fluid, mucus or ‘glue’ accumulates) but they are often prohibitively expensive, costing up to £3000. Bone conduction headphones are marketed at cyclists, allowing sound from mobile phones to be directed straight to the cochlea while sound from traffic noises still accessible through the ear canals. These headphones cost ~£100 commercially (figure 1) . An initial study in 2016–2018 trialled these simple bone conduction headphones paired to a microphone for the first time in children with OME. The Hear Glue Ear app was trialled in 2019. It was codesigned with a patient Summary box