‘That’s right.’ Anna waggled the puppet. ‘Fox.’ While the little girl’s attention was caught she questioned the mother. ‘So what’s been happening, Heather?’
‘It’s Grace. She just doesn’t seem to listen to me any more,’ the young mother said helplessly. ‘She takes absolutely no notice of anything I say and she’s so loud all of a sudden. She shouts all the time.’
Anna frowned. ‘How long has it been going on for?’
‘I don’t know.’ Heather shrugged. ‘A couple of months, I suppose. We had a terrible winter with her as you know. We virtually lived in your surgery with colds.’
Anna tickled Grace’s ear with the puppet and reached across her desk for some equipment. ‘How’s her speech?’
‘Well, she was doing really well but if anything she’s slipped back.’ Heather gave a rueful smile and cuddled the little girl closer. ‘Whoever said being a mother was easy? Do you think it’s just her age? That she’s just being naughty?’
‘No, I don’t. I suspect that she might have glue ear,’ Anna said calmly, judging whether it was a good moment to abandon the fox in favour of a clinical examination. ‘Heather, hold out your hand. I need you to take over acting duties while I take a look at her ears.’
Heather dutifully slipped her hand inside the puppet, leaving Anna to concentrate on the little girl.
‘Grace, I’m just going to look inside the fox’s ears,’ she said cheerfully, ‘and then I’m going to look inside yours.’
Grace watched with round eyes as Anna pretended to look inside the puppet’s ears, then she sat still while Anna gently used the auriscope to examine her.
‘I’m just checking that there’s no wax or foreign bodies,’ she murmured as she examined the eardrum. ‘Oh, yes, there’s the problem. I see it. The eardrum is very dull and looks indrawn. She definitely has glue ear.’
‘Glue ear?’ Heather frowned. ‘What exactly is that?’
‘It’s a condition where the child has fluid deep in the ear,’ Anna explained, ‘but without signs of infection. It’s called glue ear because the fluid tends to be like runny glue—thick, clear and sticky.’
Heather pulled a face. ‘Sounds awful. But why does that make her shout?’
‘Because I suspect it is affecting her hearing.’ Anna reached for a pad and scribbled a simple diagram. ‘People can hear because sound waves are transmitted via their eardrums and tiny bones inside the middle ear. The eardrum and bones vibrate.’
Heather stared at the diagram and pulled a face. ‘I was always bottom in biology.’
Anna smiled and put the pencil down. ‘Doesn’t matter. All you need to know is that in glue ear the middle ear, which is usually full of air, becomes filled with a sticky fluid and that damps down the vibrations.’
‘And stops the child from hearing?’
‘It can do.’ Anna stood up. ‘It’s very common in children so don’t think Grace is the only one. Speech is affected because she isn’t hearing well.’
‘So what do we do about it?’
‘Fortunately glue ear almost always settles down of its own accord but if Grace’s hearing gets worse then we may need to look at referring her to an ENT specialist. But at the moment I don’t think we should do that. I’m going to refer her to the audiology department for an assessment of her hearing and we’ll take it from there.’
‘So she doesn’t need antibiotics or anything now?’
Anna shook her head. ‘She doesn’t have an infection so they won’t work. I’m fairly confident that if we leave it alone it will go by itself, but we’ll keep a close eye on it and if we’re worried at any point then we can refer her.’
‘I’m not wild about her having an operation,’ Heather admitted, and Anna smiled sympathetically.
‘I doubt it will be necessary so let’s cross that bridge when we come to it. I’ll refer her to Audiology today and you’ll get a letter from them in the next month or so, inviting Grace to come for a test.’
‘Thanks, Anna.’ Heather stood up and brushed her curls away from her face, her cheeks slightly pink. ‘I heard a rumour that our Sam’s back. Is it true that he’s going to be working here for the summer?’
Anna stiffened. Not if she could find a way out of it. ‘Well, he’s here at the moment, but he may not be able to stay for the whole summer.’
At least, not if she had anything to do with it.
‘Oh, I hope he can,’ Heather enthused, shifting the toddler more comfortably in her arms. ‘I mean, it’s so brilliant having him. I never miss him on the telly. He’s so sympathetic, isn’t he? So warm. Can’t believe it’s our Sam, really.’
Our Sam.