Grommets

August 20, 2014
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A grommet is a tiny plastic tube, which is inserted into the eardrum, allowing air to pass into the middle ear and fluid to drain away.

Grommets are used to treat otitis media with effusion (glue ear) and occasionally they are used in the treatment of recurrent ear infections. Otitis media with effusion (glue ear) is a condition where the middle ear becomes full of a sticky, glue-like fluid, probably as a result of poor eustachian tube function. The fluid in the middle ear prevents vibrations from passing through into the inner ear, and thus causes a hearing loss. This is a common condition in childhood, but also occurs occasionally in adults. There may well be a nasal problem, such as allergic rhinitis, sinusitis, enlarged adenoids or exposure to cigarette smoke, which may contribute to the poor eustachian tube function. In many cases, the middle ear fluid will clear without any treatment, but once it has been present for a few months the chances of it clearing spontaneously are slight, and grommets may then be used.

The operation
Grommets are inserted under a general anaesthetic (occasionally it is possible to use a local anaesthetic in adults). The operation is carried out down the ear canal, and there are no external incisions. A small incision is made in the eardrum, and the grommet is inserted with one flange below the drum and one above to hold it in position.

It is common to remove the adenoids at the same time, in children, as this reduces the risk of recurrence of glue ear. Occasionally sinus washouts or other nasal surgery may be carried out at the same time.

Insertion of grommets alone takes about 10 minutes.

Length of stay in hospital
Grommet surgery is usually carried out as a day-case. If carried out in conjunction with other procedures it may be necessary to stay overnight.

Post-operative symptoms
Post-operatively, there is usually only mild discomfort for 24 to 48 hours, and this can be relieved by a normal dose of Calpol or Paracetamol.

It is common to have a little blood stained discharge from the ears for one to two days after the operation, but if this becomes more profuse or persists, it may be a sign of infection that could require antibiotic treatment.

The hearing usually improves rapidly over a few days. Occasionally children may complain that the sound is too loud or that they have noises in their ears or of mild dizziness, all of which usually settle within a few days.

Post-operative care
a) Hair washing
Whilst the grommets are in position, there is a small risk that any water getting into the middle ear may cause an infection, and therefore, it is important that soapy water is kept out of the ears during hair washing. This can be achieved by lacing a large piece of cotton wool, covered in Vaseline, in the hollow of the outer ear to prevent water from entering.

b) Swimming
Swimming is usually allowed after 2 weeks if there is no sign of infection. You should try to stop your child from putting his / her head under water or jumping in, as a lot of water may cause infection. Splashes of water are not normally a problem. Ear plugs are not normally necessary unless he/she gets repeated infections after swimming. Using a swimming ring can be helpful.

c) Discharge from grommets
If your child gets an ear infection, it will usually present with discharge rather than severe pain. Ordinary antibiotics by mouth may well clear it up, but if the discharge persists, it may be necessary to have a course of antibiotic ear drops at the same time. Your GP can normally provide these, but if you have any problems please do not hesitate to contact us.

d) Follow-up
Grommets usually stay in position for between 9 months and 2 years. They will come out
spontaneously in most children, and the small hole in the eardrum will usually close
spontaneously. Rarely grommets have to be removed under a subsequent anaesthetic, and very occasionally the grommet leaves a small perforation in the eardrum, which may have to be repaired at a later date. There is a risk of recurrence of glue ear, particularly in children with allergies or those exposed to excessive cigarette smoke, and these children may require a further set of grommets.

You or your child will be reviewed about one month after the operation to check the hearing and then every 9 months until the grommets have come out.Length of time off school/work
You should normally take the next day after the operation off work/school.

Possible complications of grommet surgery
Grommet surgery is usually straightforward but as with any operation there is always a small risk of a complication.

a) General anaesthetic
General anaesthetics are very safe in this day and age. The Anaesthetist will visit you / your child on the ward before the operation and discuss the risks of the anaesthetic and any other concerns with you.

b) Infection
Infection of the grommet may occur and will cause discharge. This usually settles with a course of antibiotic ear drops.

c) Perforation
There is a small risk of a persistent perforation of the ear drum after the grommet has extruded. This may rarely require an operation to repair the eardrum.

d) Hearing Loss
There is a small risk of hearing loss following grommet surgery due to scarring or perforation.

e) Tinnitus (noises in the ear)
There is a very small risk of developing tinnitus after grommet surgery.

 If you have any concerns once you have returned home, do not hesitate to telephone for advice to one of the following numbers:

Level 4 ward Tel: 0117 9804088
Spire Bristol Hospital Tel: 0117 9804000
or myself for advice via my PA Mrs Beverley Bloor Tel: 0117 9804050