Grommets are small plastic tubes that are inserted into a child’s eardrum (tympanic membrane). Grommets are often used for children who suffer from persistent middle ear infections (chronic otitis media) in order to limit complications and improve hearing.
Otitis Media and Glue Ear
The ear cavity is normally filled with air, a property that is important for hearing. In otitis media, the middle ear cavity becomes infected, filling with fluid and/or pus – affecting hearing and development. The pus and fluid also put pressure on the eardrum, which may cause it to rupture. It is normal for young children to occasionally have ear infections. If a child has three or more episodes of otitis media in a six-month period, a diagnosis of chronic acute otitis media is made and may be an indication for insertion of grommets.
Another type of otitis media is otitis media with effusion, or glue ear. In this type of infection, the collection of fluid that remains after a period of weeks or months will become thick. The thick, glue-like fluid can interfere with a child’s hearing. If glue ear does not respond to other treatments or persists for an extended period of time (three-six months), the insertion of grommets may help. Otitis media can affect a child’s hearing. Hearing loss in children can adversely affect social, emotional and intellectual development, and hence, the insertion of grommets may help to reduce the impacts of hearing loss on developmental delay.
What do grommets do?
Grommets help to drain the fluid which builds up in the middle ear cavity. By draining the pus and/or fluid, the pressure in the middle ear cavity is reduced, alleviating the strain on the ear drum and improving hearing.
What is involved in the procedure?
Grommets can be inserted under local or general anaesthesia. For young children, who most commonly require grommets, the procedure is commonly performed under a general anaesthetic. This is because the patient needs to remain still during the procedure, as there is a risk of damage if the patient moves suddenly.
In most cases, there isn’t a need for surgical removal of the grommet. Eventually, the grommet will fall out of its own accord at some point. Some grommets can last up to about 4 years, whereas others will fall out anywhere between six months and two years following the initial insertion. Generally, the ear drum will heal by itself and close the tiny hole left by the grommet.
One of the main problems which can occur after the grommet has fallen out is a persistent hole in the ear drum. If the ear drum does not heal properly, another operation may be necessary to repair the hole remaining in the ear drum. Sometimes the ear drum may be affected by scarring or be thinner than normal after grommets are inserted. In most cases, this doesn’t affect hearing but may mean that the ear drum is at an increased risk of perforation. As with all surgical procedures, there is a risk of developing infection after the operation. Bleeding may also occur after surgery.
If the grommets fall out too early and otitis media is still a problem, it may be necessary to undergo a second operation to re-insert the grommets. In some cases, there may be another cause for hearing problems in the child in the middle ear or elsewhere, and the grommets may not result in hearing improvement. Once the problem is identified, the appropriate management can be implemented.