Grommet Insertion
A grommet is a plastic tube that is placed across the tympanic membrane to allow ventilation of the middle ear
Reasons why grommets are inserted
Glue ear (otitis media with effusion) with hearing loss
Recurrent ear infections (recurrent acute otitis media)
Retraction pocket within the tympanic membrane
Operation
The operation is performed as a daycase under general anaesthesia (usually takes 5 to 10 minutes) and may be combined with an adenoidectomy.
3 Stages (G3 - G6)
Making an incision in the tympanic membrane (myringotomy).
Removal of the glue by microsuction.
Insertion of the grommet into the tympanic membrane.
What to expect after the operation
The surgery is relatively painless and most children are back to their normal selves within a couple of hours after waking from anaesthesia. They are not aware of the presence of the grommet .
If there is some discomfort this will respond well to simple analgesics such as Calpol.
There may be some discharge from the ears which usually settles within a few days.
Antibiotic drops are often prescribed to use for a few days to stop any discharge drying and blocking the grommet.
Children may go return to school a couple of days after the operation.
A clinic check is needed 2 weeks after surgery to ensure that the grommet is functioning and that the hearing has recovered.
Questions and Answers
How do I take care of grommets?
Care is needed to avoid water getting through the grommet behind the ear drum as this will cause an infection. This is mainly an issue with washing with soapy water and it is best that the ear is blocked to prevent this from happening. Gentle swimming is not really an issue but if your child jumps or dives into the pool an infection may develop. One can protect the ears by wearing swim plugs which may be purchased from sports or chemists or can be custom made for your child's ear. A simple option in the bath can be placing cotton wool smeared with Vaseline into the ear.
Can my child swim?
Swimming is usually not a problem, however if your child likes to jump into the water or swim underwater then it would be best to wear swim plugs.
Swimming in the sea is probably more risky because of the waves and swim plugs are recommended.
Do the grommets have to be removed?
No, the grommets normally come out by themselves, usually after 9 to 18 months. They are carried out of the ear canal naturally.
When the grommets fall out, will my child need another set?
About 20 – 25% of children who have had a set of grommets will develop glue ear again and need a further set of grommets.
Are there any problems that may happen with grommets?
Ear infections are the most common complication from grommet insertion. About 25% of children will have one ear infection while the grommet is in place. These present as a discharge and are not usually painful. Infections are often due to water contamination and swimming may have to be restricted if a frequent problem. They may also occur with a cold that results in a middle ear infection which discharges through the grommet. Treatment consists of topical antibiotics and avoiding water contamination. Sometimes oral antibiotics are needed.
It is important to have the ear checked after the infection has resolved to ensure that the grommet has not been pushed out or become blocked.
Scarring of the ear drum (tympanosclerosis) may occur but is usually of no consequence. Such scarring may also occur with glue ear and ear infections.
After the grommet comes out the hole behind usually closes. In 1-2% of children this may not happen. If this fails to close then further surgery is needed to close the perforation and this is carried out after the age of 8 years.Gr