GROMMETS & VENTILATION TUBES

 

What are grommets?

Grommets are small plastic tubes that are inserted into the ear drum (see image). They allow air to pass directly across the ear drum, equalising the pressure on each side. Why are grommets inserted? Grommets are inserted for a number of reasons, including:

  • Glue ear. This is occurs when mucus accumulates on the inside of the ear drum. This can cause a number of symptoms such as: hearing loss; a blocked sensation in the ear; delayed speech in children; poor balance; behavioural problems in children. It is a common childhood condition, but can occur in adults too.
  • Recurrent ear infections. Grommets can help reduce or eliminate middle ear infections (“acute otitis media”) whilst they are in place.
  • When the air pocket on the inside of the ear drum is not ventilated properly (eustachian tube dysfunction). This can give rise to symptoms of a blocked ear, and the ear drum being sucked in (tympanic membrane retraction).

How are they inserted?

Grommets are usually inserted whilst the patient is asleep (general anaesthetic), although it is possible to put them in under a local anaesthetic. The procedure takes about 5 minutes. A microscope is used to magnify the ear drum, and a small incision made. If there is any mucus present (glue ear), this is removed using suction. The grommet is then placed in the incision.

Are there any alternatives to surgery?

Possible alternatives to grommet insertions exist, although it depends on the reason for insertion. Glue ear. Often glue ear settles by itself. For this reason, a period of observation, usually three months, is often undertaken before grommets are inserted. In some situations an autoinflation device, such as an Otovent Balloon, can be helpful. Autoinflation devices help you ‘pop your ears’ in a controlled and safe way.

What are the risks of grommet insertion?

  • Grommet insertion is usually a very low-risk, routine procedure. As with any operation, occasionally problems occur:
    Bleeding – it is extremely rare for this to be heavy. Very occasionally patients can have some bloody discharge from the ears for a day or two following surgery
  • Infection – About 5% of children have infections whilst the grommets are in place. The commonest reason for this is getting the ears wet. Infections tend to cause the ear to discharge, but it is usually painless. If you do have an infection, in most cases they are easily treated with a course of antibiotic drops in the ear. Very occasionally children have repeated infections requiring removal of the grommet.
  • Hole in the eardrum (perforated tympanic membrane) – in the majority of cases the grommet falls out of the eardrum into the ear canal, and the eardrum heals itself. However, in 2% of cases (one in fifty) the eardrum doesn’t heal leaving a small hole in the eardrum. This can be surgically repaired if need be.

What happens after surgery?

Grommets usually stay in place for 4 to 12 months. Occasionally they come out sooner, often as a result of an ear infection, or an ear drum that is very ‘sucked in’ or retracted. Rarely the grommets stay in. If this occurs, I recommend removing them after 3 years. This is a very simple procedure.

It is important to keep soapy water out of the ears whilst the grommets are in place. The soap reduces the surface tension of the water, meaning it is able to pass through the grommet making infections more likely. Whilst there isn’t any good evidence that swimming leads to ear infections with grommets in, I usually suggest wearing ear plugs whilst swimming and recommend avoiding diving below the surface of the water.

Flying is usually much easier after the grommets have been inserted, as the grommet allows the air pressure on each side of the eardrum to equalise.

Grommets don’t ‘cure’ glue ear, although most children will grow out of the problem whilst the grommets are in place. However, about one in five children will need further grommets inserted. If the adenoids are removed (adenoidectomy), this chance is slightly reduced.

Useful links:

http://www.patient.co.uk/leaflets/grommets.htm
https://www.entuk.org/ent_patients/ear_conditions/grommets