Grommets (tympanostomy or ventilation tubes)
Grommets (tympanostomy or ventilation tubes)
Key points to remember about grommets
- grommets are tiny plastic tubes inserted into your child's ear drum in a short operation
- grommets may be recommended if your child has glue ear that won't clear up, or frequent ear infections
- grommets allow air into the space behind the ear drum (middle ear) which reduces the risk of fluid building up there
- if an infection does occur, the resultant pus flows out through the grommet
It may be helpful to first read the following pages which discuss the process that may have led to the suggestion of grommets for your child:
What are grommets?
Grommets, also called tympanostomy or ventilation tubes, are tiny plastic tubes which are inserted into a small slit in your child's ear drum in a short operation.
You can see how tiny a grommet is when it's placed on an adult finger, or next to a millimetre ruler.
The following diagram and photo show a grommet in place in an ear drum. (The diagram uses the terms ear tubes and tympanostomy tubes to refer to grommets).
How do grommets work?
Grommets maintain normal middle ear pressure by allowing air into the space on the other side of the ear drum, from the outside. This reduces the risk of fluid building up in that space. If an ear infection does occur, the resultant pus flows out through the grommet, limiting the pain your child suffers. If your child develops an ear infection with grommets in place, your doctor can use topical treatments (such as prescribed ear drops which are put directly into the ear) rather then oral antibiotics. Studies have shown that topical treatments are more effective than oral antibiotics in treating discharging ears.
Grommets are a temporary measure and will 'buy time' until hopefully your child's Eustachian tubes grow to a sufficient size to work naturally. The Eustachian tubes connect the space behind the ear drum (middle ear) of each ear to the back of the nose. (See the ear infections page for an explanation about why children's Eustachian tubes don't work as well as in older children and adults).
Most grommets usually stay in place for about 6 to 18 months and come out by themselves.
When might my child need grommets?
Grommets may be recommended for glue ear that won't clear up or for frequent episodes of acute middle ear infections; as a general guideline, if your child has had:
- middle ear fluid (glue ear) for more than 3 months, depending on the degree of hearing loss
- 6 acute ear infections in one year, especially if the infections have occurred in both ears
- repeat infections through the summer months, when such infections should be less likely to occur
- previous complications because of ear infections
How successful is the operation?
With grommets in place, any hearing loss caused by the pre-existing fluid in the space behind the ear drum will be reversed.
Parents often report a better quality of life for their children after grommet insertion with better sleeping and overall behaviour.
Who will perform the operation?
A specialist ENT (ear nose and throat) surgeon (also known as an otolaryngologist or ORL surgeon) will perform the operation.
What happens to my child during the operation?
- your child will require a brief general anaesthetic
- a small slit is made in the drum and the grommet is inserted into this
- the surgery usually takes about 10 to 15 minutes
How long will my child need to be in hospital after the operation?
When your child has recovered and is wide awake, they are usually allowed to go home. This is often an hour or so after the operation.
What can my child expect after the operation?
There is not usually any pain in the ears after grommet insertion. Although your child may be a little unsettled at first, they are usually back to normal after a few hours. They can usually return to school the following day.
Many parents notice an immediate improvement in their child's hearing. Travelling home with hands over ears because of the 'loud' noises is not uncommon.
Some children will have discharge from their ears after grommets have been inserted. This is not usually painful and is usually treated with ear drops. See your family doctor if this happens. If your child's ear discharge continues, your family doctor may send your child to an ear nurse specialist or ENT specialist.
Are any precautions necessary once my child has grommets in place?
Doctors vary in their recommendations about ear protection for your child in water (when swimming, shampooing, showering and bathing). Some children get ear infections and resultant discharge. Ask your surgeon about this at the time of the operation. You can also discuss this with your family doctor or ear nurse.
Will my child need to have repeat surgery?
Some children continue to have ear problems (glue ear and/or recurrent ear infections) once the grommets come out. They may require a further set(s) of grommets.
Sometimes removal of the adenoids is recommended. There is some evidence that removing the adenoids is helpful in those children who require a second or subsequent grommet insertion. The adenoids sit at the end of the Eustachian tubes at the back of the nose and can block the tubes if they become swollen.
- the tonsillectomy and adenotonsillectomy page on this website
What are the possible complications?
A grommet may occasionally block. If this happens, your child will need ear drops to help clear it.
A small number of children may have persistent or frequently recurring discharge from their ears.
A small but significant risk exists of a persisting hole in the eardrum after the grommets come out. If this happens, an operation to repair the hole may be necessary when your child is older, usually around 8 to 10 years of age.
In a small number of children, grommets may not come out by themselves within 3 years. If this is the case, your child may need a further brief general anaesthetic to remove the grommets. The decision to remove working grommets must be weighed up against the possible risk of the return of ear infections and glue ear. You can discuss this with your family doctor and/or ear specialist.
When should I seek help?
See your family doctor or ear nurse if your child has any discharge from their ears. Your family doctor may take a swab. This will identify any potential bacterial cause for the discharge so that your child can receive targeted treatment - usually ear drops.
Some areas have mobile children's ear clinics which visit schools and early childhood education centres. If your area has a mobile clinic, you could also talk to the ear nurse specialists who staff these. They are specially trained to diagnose, treat, monitor and refer for children with middle ear problems.
Starship Foundation and the Paediatric Society of New Zealand acknowledge the cooperation of Procare Health Ltd in the development of this content. Procare Health Ltd provides GP (general practice) services in the greater Auckland area.
Reprinted with permission from 'Earaches: A painful problem for many children,' January 1 1999, FamilyDoctor.org. Copyright © 1999 American Academy of Family Physicians. All rights reserved.
Thank you to Colin Brown, consultant otolaryngologist and ear surgical specialist, for providing the photo of the grommet in place in an ear drum, from his personal collection.