Grommet Surgery

What is ‘Glue Ear’?

Acute Otitis Media (AOM), or middle ear infection, is a common condition that is most regularly seen in children aged 6-24 months. It is the most common infection for which antibiotics are prescribed, and whilst risk decreases with age it occurs in older children, teenagers and adults. Complications of AOM can be severe, with worsening infection and physical damage resulting in delayed language development, learning disabilities and hearing loss.

This infection can result in an effusion, the trapping of liquid behind the eardrum that thickens and becomes a gluey paste. This is also known as ‘glue ear’ and is the complication that is the major cause of hearing loss and learning difficulties from a middle ear infection. Children, who have smaller drainage tubes, are less able to drain these effusions, so this can last for weeks or months with each infection. These can be painful and uncomfortable, and in children not yet able to speak sometimes the only hints are pulling at the ear and knowing your child is in pain.

What do Grommets do?

Grommets are little tubes that work as small drains through the ear drum. They are an ideal solution when glue ear persists longer than 3 months or starts to cause problems such as hearing loss and speech/language delays. The surgery for inserting them involves the surgeon making a small cut in the ear drum and inserting the grommet, which usually takes 10-15 minutes, under a general anaesthetic.

As glue ear is caused by fluid remaining in the middle ear, because it cannot be drained properly, using grommets to allow the fluid to drain out prevents it from sitting and becoming a paste. The risk of ear infections is greatly reduced with this procedure, and hearing improvements are seen rapidly – often within days to weeks.

What kinds of problems can grommet surgery treat?

• Glue ear, by draining fluid that builds up
• Repeated ear infections, which often cause pain and discomfort
• Learning, speech and comprehension delays caused by blockage in the ears

Grommet surgery is a popular surgery because it offers a variety of benefits for those that need it. Some of these benefits include:

• Hearing. If you’ve had a blocked ear before, you know much of an impact it can have on your ability to hear clearly. Imagine what this may be like for a child over the course of a few months – not being able to hear from one direction properly, hear their teacher in background noise, and so on.
• Speech and Language. Speech develops at a rapid rate over childhood. Early childhood language and comprehension development is crucial, and hearing problems caused by glue ear can often be mistaken for learning impairments. The good news is that correcting glue ear often results in rapid improvements in language, and most children catch up quickly with their age group with any problems being completely corrected.
• Learning. Hearing and speech are cornerstones heavily relied on in early education, with difficulties resulting in developmental delays. As these delays are commonly caused by repeat ear infections and glue ear, grommet surgery can completely resolve these issues letting your child get back up to speed and achieve their full potential.
• Comfort. Ask any parent - pain and discomfort can be a nightmare when it comes to younger children. Repeat ear infections can cause a great amount of pain for anybody but are especially distressing in children. Glue ears also occasionally cause a niggling discomfort in children. Grommet surgery dramatically reduces the risk of repeat infections, improving quality of life not only for your child but for yourself and any other family members.

What are the risks of grommet surgery?

Every significant surgery carries risks, including infection, bleeding and adverse reactions to anaesthesia. Risks specific to grommet surgery are thankfully relatively minor, and include:

• Grommet blockage. Due to the way grommet works, they may occasionally block. If this happens, ear drops are used to help clear them out and get them working the way they should be. Sometimes, recalcitrantly blocked grommets need to be removed and replaced with new, non-blocked grommets.
• Discharge from ear. Whilst grommets generally decrease the frequency and severity of recurrent ear infections, the middle ear is technically no longer ‘water-proof’ and so sometimes, bacteria can enter the ear through the grommet, in contaminated water. This results in ear discharge. Your surgeon will generally advise some degree of water precautions for your child’s ears, and thankfully, with a grommet in the ear, any infections are generally easily treated with antibiotic ear drops.
• Incomplete closure. After the grommets are removed, there is a small but important risk that the hole through which they are inserted doesn’t close up by itself. In this case, an operation is sometimes needed to help close up the hole when your child is older, usually around 8-10 years of age.
• Retained grommets. Usually, grommets fall out by themselves, on average after 9-12 months, and 3 years at most. If they do not come out after this time, you will make a decision with your specialist to weigh up the risks of the return of ear infections and glue ear against brief general anaesthesia to remove the grommets.

Is it easy to perform grommet surgery?

In children all surgeries are a bit more complicated because their bodies act and respond differently to how older people do. Grommet is a minor surgery that usually takes about 10-15 minutes, but the following should still be considered:

• General anaesthesia. Grommet surgery is usually performed under a short period of general anaesthesia to best look after your child and to ensure the procedure is performed safely.
• Risk of infection. The ear canal is a small tube, so the surgeon needs to be careful placing grommets in to reduce risk of causing an ear infection or minor damage to the eardrum. The actual grommets themselves are only a few millimetres in size.
• Repeat surgery. As each eardrum and ear canal are different, sometimes repeat surgery is needed to put new grommets in or optimise existing ones. Your surgeon will consider your unique situation and advise of any specific risks.

What do I need to do after grommet surgery?

Normally there is a small amount of oozing or bleeding from the ear for a day or two following surgery. You should speak to your doctor if there is a lot of pain or if this oozing or bleeding continues more than five days. Depending on the situation and normal activities of your child, your doctor may recommend avoiding swimming for a short time after surgery, usually a few weeks.

What is recovery like?

The grommets will usually fall out themselves after 6-12 months, without any harm to the eardrum. The eardrum almost always heals completely by itself once the grommets fall out. Your GP and specialist can easily check in the ears to see if they are still there, so it’s not important to make sure you find them if they fall out.