Grommets
The most common reasons to insert grommets are for persisting glue ear (otitis media with effusion) or recurrent ear infections. Occasionally grommets are inserted for other reasons, such as to treat retraction of the ear drum. Grommets may also be referred to as ventilation tubes.
Grommets are small tubes, around 3mm in size and usually made of plastic, that are placed in the eardrum. They have a small hole through the middle which allows air to pass through the eardrum to "ventilate" the middle ear, and equalise the pressure on either side of the ear drum. By allowing air through into the middle ear, infections and glue ear are reduced, and hearing levels improved.
Procedure
Grommets are inserted under a general anaesthetic (the child is fully asleep), and typically takes 20 minutes. Your child will be away from you for around 45 minutes though, as time is also needed to put the child to sleep and wake them up from the anaesthetic.
Pain following the operation is minimal, and most children are ready to return to nursery or school the following day. Occasionally a small amount of blood stained fluid may leak from the ear in the first two days, but this is not concerning. I send children home with painkillers by mouth , and antibiotics ear drops for 5 days to help the healing process.
Grommets usually stay in the ear between 6-18 months, with the average being around 9-12 months. The ear normally pushes the grommet out itself, and they rarely need to be removed.
After the grommets fall out and the ear drums heal, there is a chance the glue ear or infections return. Therefore, around 1 in 5 children may require a second set of grommets.
Post Operative Advice
I send children home with paracetamol to be used as needed, and antibiotic ear drops (ciprofloxacin) for 5 days (2 drops, twice daily in each ear).
A small amount of blood stained discharge from the ears is common for 1-2 days after grommets. The ciprofloxacin ear drops help prevent drops of blood from blocking the grommet.
I advise keeping the ears dry for 10 days after surgery. During this period, cotton wool smeared with vaseline and placed in the ear is useful in the bath.
After 10 days most children with grommets can swim and wet their ears in the bath, and rarely have any problems. If discharge occurs, a further course of ciprofloxacin ear drops may be needed.
Children can fly 2 days after surgery, and as the grommets equalise ear pressure, they rarely have any pain or pressure symptoms during take-off or landing.
Small Post Operative Risks
Around 5% of children can suffer from recurrent or persistent ear infections with grommets in place, and these can be treated with 7-10 days of ciprofloxacin ear drops (2 drops, 3 times daily). If problematic, the best advice is to prevent bath and swimming pool water from entering the ears, using ear plugs and a swim cap. Rarely, if problems persist, grommets may need to be removed.
The ear drum will normally push the grommet out after 9-12 months, and heal up after this. However, around 1-2% of children can be left with a small hole in the ear drum (tympanic perforation) after the grommet falls out. If the perforation doesn't heal, a small operation can be performed to repair the hole, usually when the child reaches 10 years old.
Occasionally a grommet can become blocked, or be pushed out from the ear earlier than expected. If the other ear is healthy, then the child can usually be monitored in clinic. If problematic, another grommet could be re-inserted.
Other risks, such as trapping of skin in the ear, are very rare