Your child's doctor may recommend grommets if your child has glue ear that won't clear up, or if has frequent ear infections.
Key points to remember
- grommets are tiny plastic tubes inserted into your child's ear drum in a short operation
- your child's doctor may recommend grommets if your child has glue ear that won't clear up, or has frequent ear infections
- grommets allow air into the middle ear (the space behind the ear drum) which reduces the risk of fluid building up there
- if an infection does occur, the pus comes out through the grommet
What are grommets?
Grommets are also called tympanostomy or ventilation tubes. They 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 is on an adult finger, or next to a 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 middle ear, from the outside. This reduces the risk of fluid building up in that space. If your child does get an ear infection with grommets in place, pus can flow out through the grommet. Your doctor can prescribe ear drops rather than antibiotics by mouth. Studies show that these ear drops are more effective than antibiotics by mouth in treating discharging ears.
Grommets are a temporary measure and will 'buy time' until your child's eustachian tubes mature to work naturally. The eustachian tubes connect the middle ear (the space behind the ear drum) of each ear to the back of the nose.
Most grommets stay in place for about 6 to 18 months and fall out by themselves.
When might my child need grommets?
Your child's doctor may recommend grommets for glue ear that won't clear up or for frequent ear infections. They are more likely to recommend grommets if your child has had:
- 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 happen
- previous complications because of ear infections
How successful is the operation?
With grommets in place, any hearing loss caused by fluid in the middle ear will get better.
Parents often report a better quality of life for their children after grommet insertion with better sleeping and overall behaviour.
Who will do the operation?
A specialist ENT (ear, nose and throat) surgeon or registrar will do the operation.
What happens to my child during the operation?
- your child will need a brief general anaesthetic
- the surgeon makes a small slit in the ear drum and puts the grommet in
- 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.
Does my child need to do anything differently when they have grommets?
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 discharge as a result. 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 or repeated ear infections) once the grommets come out. They may need grommets again.
Sometimes, your ENT surgeon may also recommend removal of your child's adenoids. There is some evidence that removing the adenoids is helpful in those children who need more than one set of grommets. The adenoids sit at the end of the eustachian tubes at the back of the nose and can contribute to ear infections.
What are the possible complications?
A grommet may occasionally block. If this happens, your child may need ear drops to help clear it.
A small number of children may have continuous or frequent episodes of discharge from their ears.
There is a small but significant risk of a hole that remains 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 or ENT 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 show any bacteria which may be causing the discharge. Your child can then receive the right 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. They are specially trained to diagnose, treat, monitor and refer for children with middle ear problems.