Grommet insertion - child

If you would like to know about the use of grommets in treating ear problems - the reasons for the use of grommets and the benefits of the use of grommets - the following information will interest you.

Before you agree to your child having a grommet insertion it is important to know all you can about it. The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your ear surgery treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

What is the problem?

Examination and tests show that your child has fluid behind their eardrum. This stops their eardrum vibrating properly and could be causing some deafness. This fluid can also lead to ear infections. The problem could be unilateral, meaning it is only in one ear, or bilateral, meaning it is affecting both ears.

What has gone wrong?

The air-filled space behind each eardrum is called the middle ear. The middle ear connects to the back of the nose by a tiny tube, called the Eustachian tube. This tube normally opens when swallowing, allowing air to pass from the back of the nose into the middle ear. Also, any secretions from the middle ear drain into the back of the nose through this tube.

If the Eustachian tube is blocked, the middle ear can fill with liquid. The liquid is thin and watery at first but it gradually becomes thick and sticky, like glue. This is why this condition is sometimes called glue ear. We do not know exactly why the Eustachian tubes become blocked. In some children, the blockage is due to enlarged adenoids. Adenoids are a collection of lymphoid tissue, rather like tonsils, but at the back of the nose.

Glue ear is the most common cause of partial deafness in school children. About one in five children develops this in their early years.

What are grommets and how do they work?

A grommet is a tiny hollow plastic tube about two millimetres across. We insert it into a two-millimetre slit that we make in the eardrum, while your child is unconscious with a general anaesthetic.

Air can now pass down the ear canal, through the grommet and into the space behind the eardrum, the middle ear. The sticky fluid dries up and goes away. Without the fluid, the ear can work normally again and the hearing becomes clearer.

The grommets usually stay in place for six to twelve months. As the eardrum heals it forces the grommet out into the ear canal.  Then in time, the grommet comes out of the ear usually along with some earwax.

While the grommet is in place, your child’s Eustachian tube, connecting the nose to the ear, will continue to grow and usually unblocks. If it unblocks by the time the grommet comes out, the fluid will not return. If it remains blocked then fluid may build up again and a new grommet may be needed. This happens in about one in five cases (20%).

Sometimes, if the surgeon suspects that your child also has enlarged adenoids that are contributing to the blockage of the Eustachian tubes then removing the adenoids as well as putting in grommets may be recommended. There is another leaflet in this series for adenoidectomy.

The aims

The aim of a grommet insertion is to let air back into the space behind your child’s eardrum. This will allow trapped fluid to dry up and improve your child’s hearing.

The benefits

With a grommet in the eardrum, your child’s dull hearing will improve. Their Eustachian tubes will continue to grow and usually unblock during the six to twelve months that the grommet remains in place. There will be a reduced risk of future ear infections. There may be a noticeable mprovement in your child’s behaviour and/or speech development along with the improvement in hearing.

Are there any alternatives?

Your child’s hearing may be improved by using a hearing aid. Ear infections can be treated with antibiotics.

What if you do nothing?

Your child’s hearing may get worse. There is also the risk of further ear infections, which may lead to a rupture of your child’s eardrum, called a perforation. Repeated perforations may cause permanent scarring of the eardrum or a permanent hole in the eardrum. These in turn can affect your child’s hearing.

Sometimes the fluid behind the eardrum goes away on its own. If it is left long enough most children eventually grow out of the problem. This can take many months or even years. During this time your child will remain deaf and is likely to have ear infections, although your doctor can treat these with antibiotics. Your child’s poor hearing will not improve until the fluid has gone and this may well affect their speech development and progress at school.

Who should have it done?

You should consider this operation if your child either:

• has fluid behind their eardrums with a noticeable loss of hearing, or
• gets a lot of ear infections

Who should not have it done?

Children who have other medical conditions that would make a general anaesthetic unsafe should not have the operation.

Author: Mr Robert Ruckley MB. ChB.  F.R.C.S.  Consultant ENT surgeon.

© Dumas Ltd 2006

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