Grommets

PLEASE NOTE - THIS INFORMATION IS INTENDED FOR GUIDANCE ONLY. IT IS NOT IN ANY WAY A SUBSTITUTE FOR A SPECIALIST CONSULTATION.

Why is grommet insertion carried out?

There are a number of reasons why we may consider inserting grommets.

The commonest is as a treatment for glue ear, generally in children but also sometimes in adults. Glue ear develops when the Eustachian tube, which connects the middle ear with the back of the nose, isn't working properly. This tube generally allows pressures to equalise (for example when flying in an aeroplane), and if it isn't working a partial vacuum can build up behind the ear drum in the middle ear. This causes the middle ear to produce fluid or "glue", which can impair hearing.

Grommets are small plastic tubes that sit in the ear drum and take over the function of the Eustachian tube. The fluid is drained away during the surgery, hopefully bringing the hearing back to normal, and the presence of the grommet allows the ear to settle down. The idea of grommets in this situation is to provide normal hearing while the ear settles and, in children, the Eustachian tube has a chance to grow and mature.

The partial vacuum may also sometimes cause the ear drum to collapse inwards, and we sometimes use grommets to try and stabilise or reverse this.

Sometimes we insert grommets as a treatment for repeated ear infections in children. It doesn't always cure the problem, but may reduce the number of infections and generally makes them less painful.

We also occasionally insert a grommet as part of the treatment of Meniere's disease

Are there any alternatives to surgery?

Many children with glue ear will get better by themselves, and there is often a period of "watchful waiting" before we suggest grommets. Even in some children with persistent glue ear the hearing loss can be quite mild and its impact on speech development, learning and behaviour can be minimal. In these children we may also recommend a conservative approach.

Just draining the fluid without inserting a grommet is generally likely to lead to the fluid returning very quickly, although it is something we may occasionally consider in certain circumstances.

Some people feel that hearing aids are a good alternative to grommets for children with glue ear, and we would be happy to discuss this with you if it is an option you would like to consider.

For repeated ear infections we may suggest a prolonged course of low-dose antibiotics instead of surgery. We may also consider adenoidectomy, either with or as an alternative to grommet insertion.

How is the surgery performed?

In children grommets are always inserted under a general anaesthetic (the child is completely asleep). In adults we may suggest either a local or general anaesthetic, depending on which you would prefer, the size of your ear canal and the type of grommet being used.

The grommet is inserted via the ear canal, with no external scars. An operating microscope is used. A small cut is made in the ear drum, any fluid present behind the ear drum is drained away and the grommet is inserted.

What can I expect after the surgery?

Unless combined with a more major procedure, grommet insertion is carried out as a day case procedure, or sometimes as an out-patient procedure if done under local anaesthetic.

It isn't particularly painful afterwards and paracetamol should provide sufficient pain relief.

There may be a small amount of bleeding from the ear but this should settle down within a few hours.

You should keep all water out of the ear(s) for 2 weeks after the operation. The best way to do this is with a large (grape-sized) piece of cotton wool smeared with vaseline and used as an ear plug. After this we generally recommend that normal bathing and showering is fine, and that you or your child can swim on the surface of the water but not jump or dive in or swim under the water.

This is because any water that passes through the grommet into the middle ear can cause an infection.

There are however a small number of children and adults with grommets who seem to be prone to infection if any water gets in their ears at all. In this situation we generally recommend custom fitted ear plugs for the bath or shower, used together with a swimming hat or head-band for swimming.

Children can fly at any time after grommets once they have fully recovered from the anaesthetic (48 hours).

The type of grommets we use most commonly usually stay in for between 9 and 18 months. They are designed to fall out on thier own as the ear-drum renews itself. You are unlikely to notice them coming out.

Occasionally they fall out sooner than this, particularly if an infection develops, and occasionally they can stay in much longer, particularly in older children or adults. Just once in a while we end up having to remove a grommet because it has been in a long time and shows no sign of coming out on its own.

When the grommets come out, about 75% of the time the fluid doesn't come back. This is because the ear has had enough time to settle down and, in children, the Eustachian tube has had a chance to grow and mature. However in about 25% of children (1 in 4) the fluid may return once the grommet has come out. In this situation we can discuss further grommet insertion, sometimes with adenoidectomy. We may also discuss the option of using a different type of grommet, designed to stay in for a longer time.

What are the risks of the surgery?

All operations, however carefully and expertly they are carried out, have risks attached.

Whilst we always do our best to operate only when we think there is a good chance of the surgery being successful, there is always a chance that the symptoms we are trying to treat may not improve following the operation.

There is a small chance of infection after grommet insertion. Please see above for recommendations about keeping the ears dry after the operation.

If an infection does occur, you will usually notice a discharge from the ear, which may be thick and sometimes smelly. The infection will usually respond well to a course of antibiotics and/or ear drops. Occasionally, however, these infections can prove quite difficult to treat and rarely we have to remove grommets because of problems with infection.

When the grommet falls out, the eardrum almost always heals behind it. In about 2% of cases (1 in 50), a small hole in the ear drum (perforation) may be left. With certain types of long term grommet this risk is much higher, about 20% (1 in 5). A perforation like this is unlikely to cause a significant hearing loss but will mean keeping all water out of the ear to reduce the risk of infection. If a persistent perforation does develop we can discuss the option of repairing it at a later date with a myringoplasty operation.

Please also see above regarding the possibility of the grommets falling out earlier or later than planned, or of glue ear returning after the grommets have fallen out.

Some people are understandably very concerned because they have heard about scarring of the ear drum after grommets. It is true that we do often see small white patches on the drum in people who have had grommets. However we also see them commonly in people who haven't. Fortunately these white patches are nothing to worry about as they don't cause any hearing loss or other symptoms.