Grommets
Middle ear ventilation tubes are sometimes called grommets. These are bi-flange tubes – tubes with a raised edge at either end – that hold open a temporary hole in the eardrum.
What issues do grommets treat in children?
Grommets are primarily used in children to treat recurrent acute otitis media (middle ear infections) or to treat hearing loss caused by fluid and mucus stuck in the middle ear, sometimes called glue ear or chronic otitis media with effusion.
Acute Otitis Media & Grommets
What is recurrent acute otitis media (RAOM)?
Young children can be prone to recurrent middle ear infections, where a virus or bacterial infection causes mucus to become trapped in the middle ear and overgrow with bacteria.
What problems does recurrent acute otitis media cause?
These recurring infections result in pain, fever, distress and hearing loss. Left untreated, they can cause permanent, significant hearing loss and ruptured eardrums.
How is recurrent acute otitis media diagnosed?
Recurrent acute otitis media can be diagnosed by your GP but is very under diagnosed, as it is often resolved by the time a patient gets to a doctor who can look in the ear. Children under 4 years old who have fever and pain without a clear explanation should be seen by their GP, because it is important to know the frequency and severity of their ear infections.
How is recurrent acute otitis media treated?
When children have had more than four episodes of recurrent middle ear infections in 6 months, or more than six episodes in 12 months, ENTs believe it is necessary to insert grommets to improve the child's quality of life and alleviate the amount of pain and suffering.
How do grommets treat recurrent acute otitis media?
Viral and bacterial infections cause the ear to produce mucus. When middle ear ventilation tubes, or grommets, are placed, the middle ear is no longer a closed circuit where bacteria can overgrow and pus can form under pressure during an infection. Instead, the microbial balance in the middle ear changes to a healthy one as a grommet allows the mucus to drain from the ear and reduces the pressure the fluid is under, meaning bacteria don’t overgrow and cause complications or severe illness.
Glue Ear & Grommets
What is glue ear?
Glue ear is a term commonly used to describe mucus trapped in the middle ear cleft. This is common in young children as the eustachian tube, which connects the middle ear to the back of the throat, does not equalise and aerate the ear very well under the age of four.
What problems does glue ear cause?
When children have glue ear, they experience hearing loss and are more prone to recurrent acute otitis media, which can cause pain, fever, distress and hearing loss in the short term, and permanent hearing loss and ruptured ear drums if left untreated.
How is glue ear diagnosed?
Glue ear is diagnosed on a hearing test by observing altered pressure in the middle ear and reduced hearing. It can also be diagnosed by otoscopy, or looking at the eardrum, which can be performed by your GP or surgeon.
How is glue ear treated?
Glue ear is common and often will resolve itself. If it has not resolved itself within 3 months or has significant hearing loss associated with it, then insertion of grommets, or middle ear ventilation tubes, is an extremely effective treatment.
How do grommets treat glue ear?
Dr McKenzie removes the glue physically and inserts the grommets to aerate the middle ear so the mucus layer is no longer stuck.
Further information about grommet surgery
How are grommets inserted?
Grommets are inserted during a short surgical procedure called a myringotomy, usually under general anaesthesia for children. Dr McKenzie makes a tiny cut in the eardrum, drains any fluid from the middle ear, and places the grommet into the opening to allow air in and fluid to drain out. The procedure typically takes about 15-20 minutes.
Where does Dr McKenzie operate?
Dr McKenzie operates at Brisbane Private Hospital in Spring Hill, Mater Children's Private Hospital in South Brisbane, and Greenslopes Private Hospital in Greenslopes for paediatric patients.
These hospitals all offer excellent paediatric nursing care support, and Dr McKenzie only uses specialist paediatric anaesthetists for your child’s procedure. This means that you can be assured that your child is in the safest possible hands as it takes a dedicated and comprehensive team of specialist nurses and doctors to safely provide paediatric ear, nose and throat surgery. Dr McKenzie has chosen these hospitals based on their ability to provide the highest level of care to your child.
Are there alternatives to surgery?
Antibiotics can be used in acute otitis media, and are particularly helpful for prolonged fever or discharging ears. They are not useful in preventing episodes, and there are some harms associated with recurrent antibiotic use. Antibiotics are usually only used when children have perforated the eardrum or have severe pain or fever or when they are under 2 years old. When children are having recurrent ear infections, antibiotics are not a good alternative to surgery as insertion of grommets is very simple, not particularly painful and extremely effective at treating the problem and preventing it from recurring.
What are the risks of surgery versus the risk of not inserting grommets?
While all surgeries carry some risks, these are well understood and carefully managed by specialist doctors and nurses. It’s important to remember that leaving a chronic condition untreated can lead to worsening health problems that may become more difficult to treat over time. Dr. McKenzie will only recommend surgery when the expected benefits clearly outweigh the potential risks.
Grommets and adenoids
The insertion of grommets can be performed in conjunction with the removal of adenoids (adenoidectomy), particularly if the child is having a second set of grommets. This is because there is evidence that removal of adenoids reduces the number of ear infections and hence reduces the subsequent requirement for repeated insertion of grommets.
Can grommets fall out?
Yes. grommets are intended to grow out of the middle ear with the natural healing processes of the tympanic membrane (eardrum). The simplest set of grommets is designed to last for 6 to 9 months, and the hole heals naturally once the grommet is extruded. You may not see the grommet when it comes out as it is only about 3mm in size. Your general practitioner or Dr McKenzie will periodically review your ears after grommet insertion to check if the grommet is in or working. Once the grommet has grown out, 70% of children will never need another set of grommets.
Ear infections with grommets
When grommets are in the ear, there is a risk that contaminated water entering the grommet can cause bacterial overgrowth and chronic discharge. Sometimes ears will discharge through a grommet when you have another upper respiratory tract infection, and this is usually self-limiting.
Swimming with grommets
Contaminated water entering the middle ear through the grommet can, on rare occasions, lead to an ear infection, so precautions need to be taken when swimming with grommets. While international guidelines state that the rate of this problem is low and it may not be worth avoiding water, these are based largely on overseas studies. Brisbane ENTs like Dr McKenzie recommend keeping grommets dry if possible because kids swim a lot in Queensland, and environmental fungus is more common, and fungal grommet discharge is difficult to clear.
Dr McKenzie advocates for a common-sense approach to grommets and water. She recommends keeping them dry if swimming initially while they heal into the ears. Showers and baths don’t require precautions at this point as long as the head is not being submerged in water. Ears can be blocked with a plug made of Blu Tack (see video below), silicone putty from the chemist, or Docs Pro Plugs, which are available from Dr McKenzie’s practice and very convenient and simple to use.
Dr McKenzie recommends letting children swim without ear plugs if a plug will distress them too much, unless they have had a discharge through their grommets before. She also recommends not letting them submerge their heads in dirty water like bathtubs, creeks or dams. While wet grommets will not usually lead to a discharging ear, Dr McKenzie can fix this issue if it does occur.