Grommets

WHAT ARE GROMMETS?
Grommets are tiny plastic buttons, with a fine hole down the middle. They are positioned in the eardrum and ventilate the middle ear. The principle behind their use is as follows:
The middle ear is normally an air containing cavity which is ventilated through a tube at the back of the nose called the eustachian tube. When this tube is temporarily impaired, the result may be fluid build-up and/or infection of the middle ear cavity. Resolution with or without treatment is the rule, usually within 3 to 4 weeks. Occasionally the condition does not clear, and failure to treat will result in hearing loss. Drainage alone will usually lead to recurrence of fluid, therefore the function of the grommet is to by-pass the eustachian tube and allow air to continuously enter the middle ear until the eustachian tube recovers.
                                             
THE OPERATION
Under a short (5 - 10 minute anaesthetic) a tiny incision called a myringotomy is made in the eardrum using a microscope. The fluid is drained and a small ventilating tube (grommet) is fitted into the incision.
                                    
HOW LONG DO GROMMETS STAY IN?
Once in place, the grommet cannot be felt and is rarely dislodged. Ventilation eliminates discomfort and hearing is usually noticeably improved. The tube normally remains in the eardrum from four to eight months, sometimes even longer. Unfortunately it is not possible to predict how long they will stay in in each case. Sometimes you will know when the grommet has come out when you see it in the child’s ear wax. When this happens, don’t be alarmed unless of course the child’s symptoms recur, in which case consult your doctor. Sometimes a grommet becomes blocked and has to be replaced, but this is unusual.
                                             
WHAT HAPPENS TO GROMMETS?
Grommets are designed to come out on their own. If the treatment has been successful, you won’t know when they come out of the eardrum and one of the reasons for coming to see the specialist every two to three months is for him to see whether they are still working or not.

ARE GROMMETS HARMFUL?
Grommets don’t cause any harm by themselves. The damage that can occur with hearing problems in children is due to the disease itself. Lack of treatment is what may be harmful in the long term.
                                             
WHAT OF THE LONG TERM?
A child’s blocked eustachian tubes will eventually open up. Sometimes it takes months and sometimes years. We believe it is important to keep an avenue of ventilation open by means of repeated grommets if necessary, until the natural avenue, the eustachian tube, is functioning again. The majority of children require no further surgery once the grommet comes out. A minority need to have grommets put in two or even three times. In a very, very small percentage of cases we seem to lose the battle and a small residual hearing loss will result from the blocked eustachian tube condition. In the vast majority of children, even if we have to treat them on and off for several years and put in grommets on multiple occasions, we end up with normal hearing and there is no further trouble. The long term outlook for the properly treated child is therefore excellent.
 

WHEN SHOULD I TAKE MY CHILD TO THE DOCTOR?

FOLLOW-UP VISITS:
Generally two weeks after surgery and then at two to three monthly intervals until the doctor is satisfied that the ears have returned to normal.
      
DISCHARGE FROM THE EAR:
Some children get discharge from the ears after the operation. Usually this settles after a short time, but occasionally can be troublesome. The discharge is not dangerous and does not indicate harm. If drainage persists, the doctor may need to clean the ears by suction or prescribe medication to hasten recovery.
      
MEDICAL ATTENTION:
Medical attention is required if your child is getting earache or is suffering from deafness again - consult your doctor as soon as possible.

WHAT CAN OR CAN’T MY CHILD DO?
One should try to keep water our of the ears. Usually water will cause no harm whatsoever, but some times can set up a slight infection which will require treatment. Swimming is permitted. The hole in the grommet is sufficiently small not to let any water through, provided the child doesn’t dive or swim underwater. It is probably best therefore to keep your child out of the sea. Be careful about bath water and hair washing as some soaps and shampoos are very irritant if they get into the middle ear. To keep water out of the ear, use Prestick, cotton wool soaked in Vaseline or some other suitable ear plug. Plain cotton wool is not effective. Otherwise your child can do whatever he or she wants to, for example, flying, football and gymnastics.