What are grommets?photo-grommet

Grommets are tiny plastic tubes with a hole through the middle, which sit in the eardrum. They let air get in and out of the ear.

Why are grommets used?

Fluid occasionally builds up behind the eardrum, a condition known as a middle ear effusion or ‘glue ear’. It is more common in young children, but can occur at any age. It is often related to a recent upper respiratory infection or ‘flu but often no cause is identified. It is thought to be more likely in people with enlarged adenoids.

Does my child have to have grommets?

Glue ear most commonly causes problems with reduced hearing or speech development, and occasionally recurrent ear infections. Glue ear very often resolves by itself, in most cases within three months. If the glue ear persists and hearing loss or other problems continue, then grommets may be required.

What are the alternatives to grommets?

  1. Medical treatment: You may already have tried topical nasal steroid nose drops or sprays to try to clear the nose and improve the drainage of the Eustachian tubes (which connect to the ears). Antihistamines are sometimes prescribed in case of coexisting allergies although they are not very effective at improving glue ear.
  2. Other operations: There are no other alternative operations to treat glue ear. Occasionally another surgical procedure might be required at the same time, such as reduction or cautery to the inferior turbinates to reduce a particularly swollen nasal lining, or adenoidectomy/tonsillectomy (see separate information sheets). In adults, surgical treatment of the Eustachian tube by balloon dilatation can also be considered.
  3. Hearing aids: This can be a good option, for example in very young children below 12-18 months old or if you are not keen on surgery. It gives equally good results as grommet insertion in that the hearing will improve although the underlying condition is not treated.
  4. No treatment: You can decide not to have any treatment if you are happy to put up with your symptoms. This is because in most cases the proposed operation is elective and is not being undertaken as an emergency; therefore you could elect to live with your symptoms if you prefer not to go through an operation. One consequence of this is that your underlying condition or problem is not being treated, therefore hearing loss and associated problems with continue, although surgery can be considered at any point in the future if medical or other treatments fail.

Tips before the operation

Speak clearly, and wait for your child to answer. Make sure he or she can see your face when you speak. Call your child’s name to get them to look at you before you speak. Let nursery and schoolteachers know that your child has a hearing problem. It may help for your child to sit at the front of the class.

Inserting grommets – the operation

This is usually done as a day case and is a simple, straightforward operation lasting around 10-20 minutes.

After the operation

Immediately afterwards, the ears may be a little sore but there should not be much pain at all and your child can begin eating and drinking soon after.

Grommets tend to improve your child’s hearing straight away although it can take a few days in some cases for the hearing to return. Some children think everything sounds too loud until they get used to having normal hearing again. This usually takes only a few days.

Your child should usually be able to go back to school or nursery a day or two after the operation.

Things that can go wrong after grommet surgery

There are some possible risks, side effects and/or complications that can happen after grommet surgery. These include:

  • Pain/discomfort: Grommet surgery is rarely painful although there might be a slight and temporary discomfort in some cases.
  • Infection: This occurs in about 1 in 10 patients and can be treated with antibiotics.
  • Bleeding: This rarely happens following grommet surgery.
  • Adhesions/scarring: Some scar tissue will inevitably develop on the eardrum. This rarely causes any long-term problems, except in patients who require multiple grommet surgery where the scarring can gradually build up and affect the hearing in the future.
  • Perforated ear drum: this occurs in about 1-2% of cases and is more common if multiple grommets have been inserted in the past as this can weaken the ear drum, or if a larger or longer-term type of grommet has been used. As long as the ear is kept dry, it rarely causes any problems although in some cases the perforation may need to be repaired. In some cases the hole can act as a form of natural grommet that can in fact be beneficial.
  • Recurrent glue ear/infections: Once the grommet falls out, it is possible that the glue ear or ear infections might return in the future. The risk of this is around 5-10%.
  • Early extrusion: Grommets usually stay in the eardrum for an average of 12-18 months and only come out of the ear when they are naturally pushed out. They can sometimes come out a lot earlier, sometimes as soon as a few weeks after the surgery. It this happens, it does not necessarily mean that there will be a problem as it is often an indication that the grommet is no longer required.
  • Non-extrusion: Similarly, the grommet may not fall out until much later or in rare cases not at all. Again this does not usually mean that there will be a problem. Grommets can stay in the eardrum quite safely even long term.
  • Reduced hearing: Very rarely the hearing can get worse after the operation due to a nerve related deafness although this is highly unusual (less than 1 in 10,000 cases).

Will I get an ear infection with my grommets in place?

It is possible but the majority of people do not get any more ear infections than the rest of the population. You will know if you have an infection as there will usually be a smelly discharge from the ear, usually discoloured either yellow, green or even bloody. You may also have a temperature.

Treatment is with antibiotic eardrops prescribed by your GP. Occasionally antibiotics by mouth may also be required.

It is important to keep the ears dry for 4-6 weeks after the surgery. This includes protecting the ears whilst having a bath or shower at home, using cotton wool mixed with Vaseline. Swimming should be avoided for two weeks, and then can be resumed with or without earplugs. If diving takes place, then earplugs should be used.

Advice following the operation

1. Water contact and swimming

Swimming should be avoided for four weeks after the operation. After this, your child can swim without earplugs, although if they undertake diving then earplugs should be used. It is important however to prevent dirty or soapy water from getting into the ear, which can be achieved by using a cotton-wool ball covered in Vaseline to plug the ears.

2. Flying

It is perfectly alright to fly in an aeroplane soon after grommets have been inserted. This is because the hole in the grommet prevents any build up in pressure within the middle ear. This means that the ear will not get painful

Follow up:

You will be seen again by your specialist in the ENT clinic around four weeks after the surgery in order to check that the grommets are still in place and working, and also to recheck the hearing. Thereafter you will almost certainly be seen again about six months after the surgery, to check on the progress of the grommets.