This article is on grommets, a common operation for children.  This is usually for acute otitis media with effusion (OME) or repeat middle ear infections (acute otitis media, AOM). The surgeon is usually an otolaryngologist. This resource is open to everyone. Patients, medical students and health professionals may find this useful. Adjacent boxes provide additional information for Medical Professionals.

You may like to read about AOM, OME or ear anatomy here.

 

What is Grommets?

Grommets are small, hollow, plastic-like tubes. They are also called tympanostomy tubes. They are made to sit in the eardrum and allows air to flow freely into the middle ear. This allows ventilation and aims to prevent fluid from building up in the ear.

As inserting grommets is an operation, the decision to do this is made with your doctor or specialist.

Inserting grommets usually needs a general anaesthetic for children. This means fully ‘going to sleep’ for the operation, so that children stay still. This can also be done while awake, under local anaesthetic, although this is not common.

The surgeon will use a scope to look down the ear. The aim is to get a good view of the eardrum. They will then make a small cut near the bottom of the eardrum. Any fluid or pus behind the eardrum might be sucked out. The surgeon then places the grommet into the cut, with each end of the grommet on either side of the eardrum.

 

What are the indications?

Grommets are one of the most common operations in children. Some adults may also need grommets.

A common reason for getting grommets is repeat infections of the middle ear, also called acute otitis media (AOM). If a child has more than three separate episodes of AOM in six months, or more than four in 12 months, grommets may be recommended.

Another reason is when fluid keeps building up in the middle ear, also known as otitis media with effusion (OME). This happens without signs of an infection (e.g. pain, fever). This may be recommended when fluid is present for at least three months, or if there are repeat episodes. OME can cause hearing loss due to the build-up of fluid. This can affect a child’s speech or language development. Grommets may be recommended if this is a concern.

The risk factors for getting grommets is like those for middle ear infections (e.g. sick often, smoking exposure, going to kindergarten/day-care).

 

What happens before surgery?

Before surgery, patients are asked not to eat or drink anything six hours before their appointment time.

The anaesthetist will also meet you on the day of surgery, or in the days leading up to it.

 

How long is the surgery?

Inserting grommets is usually a quick operation, taking between 15 – 30 minutes.

 

After the operation

Patients can go home the same day after the operation.

Your specialist will organize a follow-up plan after the operation. This is to make sure the grommets are in place and check for any problems.

Even after having grommets put in, you may notice some discharge from the ear. This may mean there is another infection but seeing this means the grommets are doing their job. Your doctor may prescribe antibiotic eardrops; people usually do not need tablet antibiotics.

People with grommets can still swim or take baths as water usually does not go down the small grommet. Ear plugs may be advised in certain cases: dunking your head in the bath, swimming in un-treated water (e.g. natural lakes, rivers, rockpools) or going more than 2m underwater.

Different types of grommets are designed to stay in the ears for a different amount of time. Most stay in for six to 18 months. In most cases, grommets fall out of the ear by itself. The hole made usually patches itself up afterwards.

 

What are the risks?

In a very small number of cases, the grommet does not fall out by itself. If the grommet hasn’t come out after two or three years, surgery may be needed to remove the grommet. This is because the first hole to insert the grommet may become permanent after this time.

In rare cases, the grommet falls IN to the ear. This may require surgery to remove.

In most cases, the hole made to fit the grommet closes by itself. In some cases, this hole doesn’t close properly. This can be a risk for further infections and may also affect hearing as well. This hole can be fixed by another operation.

In some cases, there can be physical changes to the eardrum itself after grommets are put in. A white plaque of calcium and phosphate can build on the eardrum. This usually has little effect on hearing.

After grommets are removed, ear infections may happen again. This is because the original problem has not resolved. A repeat operation for grommets may be recommended. Most children will grow out of their ear problems by age 10, and not need grommets afterwards. If you need many grommet operations, this can cause thinning of the eardrum due to the cuts made.

 

Are there alternative options?

When there are repeat infections or episodes of fluid/pus build-up behind the eardrum, it is usually recommended to have grommets.

In some cases, antibiotics can be used to both treat the infection as well as be used long-term, to try lower the risk of another infection happening. This can have downsides, including antibiotic resistance. This is when the antibiotic becomes less effective against the bacteria causing an infection as it gets ‘used to’ the antibiotic.

 

Further reading:

https://www.kidshealth.org.nz/grommets

 

References:

https://www.nice.org.uk/guidance/cg60/chapter/1-Guidance

https://journals.sagepub.com/doi/pdf/10.1177/0194599813487302

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012017.pub2/full

 

Author + Affiliation:
Brian Yeom, MBChB BMedSc(Hons). Counties Manukau Health

Date of Publication +/- Review:

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