Hearing is one of the most important senses for both children and adults. From a young age, children rely on clear hearing for the development of speech and language. Adults depend on it for their work, their social connections, and their enjoyment of everyday life. When ear problems occur, even temporarily, the impact can be significant. Parents may notice their child is not responding to voices, teachers may report that a student struggles to follow instructions, and adults may feel frustrated by constant ear fullness or muffled hearing that makes conversations harder.
In Melbourne, conditions such as glue ear, blocked ears during flights, and chronic ear infections are frequent reasons for families to seek medical help. These problems are not always urgent, but if left untreated, they can affect development, education, and quality of life.
At Melbourne ENT in St Kilda East, patients are cared for by Dr Stephen Kleid, an ENT and Head & Neck Surgeon with decades of experience, and Dr Simon Braham, an ENT Surgeon with advanced training in both Australia and the United States. Both surgeons have worked in Victoria’s most respected hospitals, including the Royal Melbourne Hospital, the Royal Victorian Eye and Ear Hospital, and Masada Private Hospital, and bring this breadth of expertise into their private practice. Together, they offer local families and adults comprehensive options to restore ear health and middle ear aeration in a safe and evidence-based manner.
Understanding the Middle Ear and Eustachian Tube
The ear is a delicate and highly specialised organ made up of three sections: the outer ear, the middle ear, and the inner ear. The middle ear, located just behind the eardrum, is a small air-filled chamber containing three tiny bones called the ossicles. These bones amplify sound vibrations from the eardrum and transmit them to the inner ear, where the sound is processed by the brain. For the ossicles to work properly, the middle ear must remain filled with air at the same pressure as the outside environment.
The responsibility for maintaining this balance falls to the Eustachian tube, a slender passageway connecting the back of the nose to the middle ear. The tube normally opens during swallowing, yawning, or chewing, allowing fresh air to enter and fluid to drain. In children, the tube is shorter and more horizontal, which makes it more prone to blockage, but adults can also experience dysfunction.
When the Eustachian tube fails to work correctly, pressure differences develop. Fluid may accumulate behind the eardrum, leading to a sensation of fullness, muffled hearing, or even pain. The simple act of aeration, or ensuring airflow through the middle ear, becomes compromised. Treatments for middle ear aeration aim to restore this balance, relieve symptoms, and prevent complications.
When Aeration Fails: Common Conditions
Glue Ear (Otitis Media with Effusion)
One of the most common consequences of poor middle ear ventilation in children is glue ear, also known as otitis media with effusion. This condition occurs when sticky fluid remains trapped in the middle ear for weeks or months after an infection or cold. Parents may notice that their child is speaking less clearly, asking for the television volume to be turned up, or appearing distracted at school. Glue ear is not usually painful, but it can significantly reduce hearing and delay speech development during critical learning years.
Recurrent Ear Infections
In both children and adults, recurrent ear infections are another clear sign of poor aeration. A blocked Eustachian tube creates an environment where bacteria and viruses can thrive, leading to repeated infections. Each infection causes discomfort, possible fevers, and may involve the eardrum bursting to release fluid. Over time, repeated infections can affect hearing permanently.
Baro-Challenge Ear Problems in Adults
Adults are not immune to aeration problems. Many experience discomfort during flights, diving, or even driving up into the hills of Victoria. This is often referred to as baro-challenge-induced Eustachian tube dysfunction. Normally, swallowing helps equalise pressure changes, but in some adults the Eustachian tube simply does not open adequately. The result is a painful, blocked sensation, and in some cases the symptoms persist long after the flight or dive has ended.
Impact on Quality of Life
The consequences of aeration failure reach beyond the ears themselves. For children, hearing loss can delay speech and literacy, making school more difficult. For adults, the frustration of blocked ears can cause fatigue and impact social or professional life. For families, repeated GP visits, multiple courses of antibiotics, and ongoing worry about a child’s development can be exhausting.
Stepwise Care at Melbourne ENT
At Melbourne ENT, the approach to middle ear problems is careful, structured, and tailored to each patient. Rather than rushing into surgery, Dr Kleid and Dr Braham begin with a full assessment and start with the least invasive measures.
During the consultation, a thorough medical history is taken, focusing on the frequency of infections, the severity of hearing loss, and any related issues such as delayed speech in children or discomfort during flying in adults. The ear canal and eardrum are examined under a microscope, allowing even the smallest changes to be identified. A tympanometry test is often performed to measure the movement of the eardrum and pressure within the middle ear. Hearing tests, or audiology, are also essential to establish how much sound loss the patient is experiencing.
Nasal and ear endoscopy is often performed to get a full understanding of the pathology and treatment options (insert link to endoscopy)
Once the full picture is clear, a personalised plan is developed. This stepwise plan may include observation and monitoring, the use of simple techniques such as autoinflation, or surgical options such as grommet insertion or balloon dilation if necessary. The central philosophy is to use the simplest and safest option that will provide long-term benefit.
Middle Ear Aeration Methods – Evidence-Based Options
✓ Watchful Waiting & Monitoring
In many children with glue ear, patience is the best medicine. The condition often resolves within six to twelve weeks as the child’s immune system clears the fluid and the Eustachian tube regains its function. For this reason, watchful waiting is often the first step in management. Families are reassured that not all cases need surgery, and regular check-ups are arranged to ensure hearing and speech development remain on track. If the condition persists for three months or longer, or if significant hearing loss is detected, further intervention is considered.
✓ Ventilation Tubes (Grommets)
When glue ear persists and begins to affect a child’s speech, school performance, or quality of life, ventilation tubes, more commonly known as grommets, are often recommended. These are tiny plastic or metal tubes inserted into the eardrum during a short day surgery procedure under general anaesthetic. Once in place, they act as an artificial passage, letting air into the middle ear and allowing fluid to drain away naturally.
The benefits of grommets are immediate. Parents frequently notice that their child responds more quickly, speaks more clearly, and seems more engaged. Adults who undergo grommet insertion often describe an immediate relief from pressure and muffled hearing. Although grommets usually fall out on their own within six to twelve months, they provide a valuable window of normal hearing during critical developmental years. Some patients may need repeat procedures if the problem recurs, but many outgrow the condition as their Eustachian tubes mature.
Like any procedure, grommet surgery carries small risks, such as ear discharge or, rarely, a persistent hole in the eardrum. At Melbourne ENT, both Dr Kleid and Dr Braham perform this procedure regularly at Masada Private Hospital and other Melbourne facilities, providing safe and reliable outcomes.
✓ Adenoidectomy (Children Only)
In children, enlarged adenoids often contribute to blocked ears. The adenoids are located at the back of the nose, close to the opening of the Eustachian tube. When they are large, they can obstruct airflow and prevent proper ear ventilation. In these cases, removing the adenoids, known as an adenoidectomy, can greatly improve middle ear aeration.
This procedure is typically considered in children over the age of four who have persistent glue ear or require repeat grommet insertion. It is also beneficial when the child suffers from nasal symptoms such as chronic congestion or snoring. By combining an adenoidectomy with grommet surgery, ENT surgeons can address both the blockage and the fluid in one operation, reducing the likelihood of recurrence.
An assessment by an experienced ENT specialist such as Dr Kleid or Dr Braham is essential.
Addressing Patient Concerns
Parents and patients often arrive at Melbourne ENT with understandable concerns. One of the most common questions is whether children simply grow out of glue ear. The answer is yes, many children do as their Eustachian tubes mature, but in some cases the condition persists long enough to affect speech and learning, which makes timely assessment important.
Another frequent question is whether surgery is always necessary. At Melbourne ENT, the answer is no. Surgery is only offered when conservative methods such as watchful waiting and autoinflation have not worked, and only when there is clear evidence that intervention will improve hearing and quality of life.
Families also want to know how long grommets last. On average, grommets remain in place for six to twelve months before falling out naturally. Some children require repeat surgery, while others do not. Adults often ask whether they can benefit from aeration treatments, and the answer is yes. Many adults respond well to balloon dilation, and some also require grommet insertion. Each case is considered individually.
The Melbourne ENT Difference
What sets Melbourne ENT apart is not just the range of treatments available, but the combined expertise of its surgeons.
Dr Stephen Kleid has a distinguished career in ENT and head and neck surgery, with special expertise in complex nasal and throat operations as well as cancer surgery at the Peter MacCallum Cancer Centre. He has been a senior figure at the Royal Melbourne Hospital and continues to mentor younger doctors. His depth of experience means that patients can feel confident even when complex conditions are involved.
Dr Simon Braham is an ENT Surgeon with special interest in paediatric ENT, nasal and sinus surgery, and related procedures. He consults at Masada Private Hospital and has extensive experience managing children with glue ear, grommets, and adenoid problems. His expertise provides patients with a broad scope of care and reassurance that both simple and complex cases are managed with the same high level of skill.
Together, they offer a holistic service that combines advanced technical skill with a philosophy of evidence-based, patient-centred care. Patients know they are receiving advice that balances modern medical science with decades of surgical experience.
Key Takeaways for Patients in Melbourne & Victoria
Middle ear aeration is essential for hearing, comfort, and healthy development. Families should be reassured that many cases resolve naturally, but persistent problems need assessment. Autoinflation is a safe first-line method, grommets provide reliable relief for persistent glue ear, adenoidectomy can help in children with enlarged adenoids, and balloon dilation offers new hope for adults with chronic Eustachian tube dysfunction.
At Melbourne ENT, Dr Kleid and Dr Braham provide comprehensive and trusted care for both children and adults. Their approach combines the latest evidence with local expertise at Melbourne’s leading hospitals, ensuring patients receive safe and effective treatment tailored to their needs.
Medicare and Coverage for Middle Ear Surgery
In Australia, several of the procedures used to improve middle ear aeration are partly covered by Medicare when they are performed for medical reasons such as persistent glue ear, recurrent infections, or documented hearing loss. This includes grommet insertion (ventilation tubes) and adenoidectomy in children. Balloon Eustachian tuboplasty, being a newer procedure, may not always attract a rebate and often requires private health insurance or out-of-pocket payment. The exact level of rebate depends on the procedure item number, whether you are treated in the public or private system, and whether you hold private health insurance. At Melbourne ENT, families are provided with detailed fee estimates and guidance on expected rebates before proceeding with surgery, so there are no financial surprises. Patients are encouraged to bring their Medicare and insurance details to their consultation so that any questions about coverage can be addressed clearly.
Next Steps
If you or your child are living with blocked ears, repeated infections, or reduced hearing that does not improve, it is worth arranging an ENT assessment. Early review ensures that any persistent fluid or dysfunction is identified and treated before it causes long-term effects.
At Melbourne ENT in St Kilda East, Dr Stephen Kleid and Dr Simon Braham provide thorough assessments, a full range of treatment options, and careful follow-up care. They guide families through every stage of the process, from initial monitoring through to surgery if required, always with a focus on safe, natural, and effective outcomes.
To learn more or arrange a consultation with Dr Kleid or Dr Braham, please visit the website.
Further Reading
- Read more about Middle Ear Infection (AOM)
- Read more about Glue Ear (Grommets)
Medical References
- The impact of middle ear aeration on surgical outcome after intact canal wall tympanoplasty for cholesteatoma – https://www.sciencedirect.com/science/article/abs/pii/S0385814620301437
- The Measurement of Volume and Surface Area of the Middle Ear Pneumatic System and Its Clinical Significance – https://www.sciopen.com/article/10.26599/JOTO.2025.9540028
- Middle Ear Cholesteatoma – StatPearls – NCBI Bookshelf – https://www.ncbi.nlm.nih.gov/books/NBK448108/
- Risk Factors Associated with Middle Ear Barotrauma in Patients Undergoing Hyperbaric Oxygen Therapy – Yonsei Med J. 2025 Jan – https://www.eymj.org/DOIx.php?id=10.3349%2Fymj.2024.0068
- New contributions to the theory of air pressure regulation in the middle ear – ScienceDirect – https://www.sciencedirect.com/science/article/pii/S030698772500091X
- Ventilation Pathways of Middle Ear and Mastoid in Patients Undergoing Endoscopic Tympanoplasty at a Tertiary Care Center – Cureus – https://www.cureus.com/articles/391690-ventilation-pathways-of-middle-ear-and-mastoid-in-patients-undergoing-endoscopic-tympanoplasty-at-a-tertiary-care-center-in-uttarakhand-an-observational-study?score_article=true
- Permanent Middle Ear Aeration – JAMA Network – https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/602874
