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?

Some doctors recommend the use of nose drops or nasal sprays to see if they help. These may help some children if they are able to use them.

Antibiotics and antihistamines have also been suggested by some doctors but in general they are not so useful for this type of ear condition.

If the adenoids are big, removing them may help the glue ear to get better faster, so this may be discussed with you. Removing the adenoids could happen either instead of or at the same time as putting grommets in.

A hearing aid is sometimes used to improve the poor hearing and speech problems. This would mean that your child would not need an operation. This treatment only improves the hearing and speech and does not clear the glue ear, so the underlying problem may persist.

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 school teachers 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 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 should improve your child’s hearing straight away. 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 the day after the operation.

Things that can go wrong after grommet surgery

Grommets almost always fall out by themselves as the eardrum grows, pushing it out approximately 6-12 months after the operation, sometimes earlier and occasionally later. In rare cases, the grommet may not fall out. This can cause ear infections although in many cases there may be no problems at all.

The grommet can leave some scarring in the eardrum although this rarely causes any reduction in the hearing.

When the grommets do fall out, the glue ear returns in about 20% of children. In some of these cases the glue ear is only temporary or may be treated with medications. However it is sometimes necessary to repeat the operation. In a very small number of cases, more than two sets of grommets may be required although this is unusual.

Occasionally when a grommet falls out, a small hole is left behind. This usually heals up with time by itself, although rarely it may need to be repaired by another operation in order to close the hole.

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 ear drops 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 ear plugs. If diving takes place, then ear plugs should be used.

Advice following the operation

1. Water contact and swimming

Swimming should be avoided for two weeks after the operation. After this, your child can swim without ear plugs, 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 within 6-12 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, although at less frequent intervals, until the grommets have fallen out.