Grommets

What are ear grommets?

If a child’s hearing, learning, development and social skills are affected; it could be due to glue ear.

An ENT department (ear, nose and throat) will monitor this over a three month period also known as ’watchful waiting’. 90% of cases resolve themselves within a year, but in some cases the issue isn’t naturally resolved and if your child has severe hearing loss, then the ENT specialist will recommend surgery. A grommet is a small tube inserted into child’s ear during grommet operation.

What happens during grommet surgery?

During grommet ear surgery, a general anaesthetic is administered and a small plastic tube is inserted into the ear drum to drain away excess fluid and maintain the correct pressure.

The grommet insertion procedure takes around 15 minutes, so the patient will be able to go home the same day. During the first few days after inserting grommets in the ear, your child may find sounds are much louder than they are used to. They will become accustomed to this over time.

How effective is grommet surgery?

Grommet surgery is an effective glue ear treatment however it is an invasive procedure where the child will have to undergo a general anaesthetic, which could distress both the child and family. If you are uncomfortable with this you can look to alternative non-surgical glue ear treatments.

Grommets in ears typically stay in between 6-12 months, however grommets can fall out before glue ear is treated, meaning the child would have to have another operation. This happens to around a third of patients, and the more surgery a patient has the more damaged or scarred the surface of the ear drum becomes.

Despite this, it still remains one of the most popular and effective treatments for glue ear.
In 2012-2013, over 30,000 grommet insertion procedures were carried out in England:

  • One in three episodes of ear grommet operations patients were 1-3 years old (not suitable to use Otovent at present)
  • One in three of ear grommet operations patients were 4-16 years old
  • One in three of ear grommet operations patients were over 16 years old

Are there any implications and risks associated with grommets?

While the complications of grommets are relatively few, as it is an invasive operation carried out under full anaesthetic there are some potential risks and side effects.

The most common side effect of grommets is developing an ear infection, which occurs when bacteria infects the fluid inside the middle ear. Risk of infection is also increased when children swim, meaning they would need to wear ear plugs for swimming with grommets which could have a negative impact on their wellbeing.

Another side effect of grommet surgery is tympanosclerosis, occurring in around 25% of cases. The surgery can cause a thickening of the ear drum, which is usually fine, but in rare cases can cause hearing loss, particularly in patients who have had repetitive grommet surgery.

In rare cases, if the grommets do become infected, pus can form on the inside of the ear, causing a perforated ear drum which can lead to a loss of hearing. In most cases the eardrum heals by itself in 6-8 weeks. If the perforated eardrum persists, it can be treated with myringoplasty, a minor surgical procedure where tissue is used to seal the eardrum. It may be up to 24 months before this corrective surgery can be carried out and hearing aids are normally fitted during this wait.

What are the alternatives to grommets?

The risks aren’t high with grommet surgery, resulting in complications in only 2% of cases. As this is the most common elective surgery carried out on children, with approximately 30,000 cases per year, this means that around 600 children per year will suffer complications.

The fact that a third of all patients require repeat surgery means the process can be distressing on the child.

There are alternative methods to using grommets, for example autoinflation. The autoinflation is a non-invasive process and involves a child blowing into a specialised balloon using their nose. This opens up the Eustachian tube, making it easier to drain fluid from the middle ear. NICE recommends Autoinflation at any stage during ‘watchful waiting’.

Find out more about the Otovent process here.