Why your child might need grommets

If your child keeps getting ear infections or has fluid in their ear that won’t drain, their doctor may suggest grommets.

What are grommets?

Grommets are tiny ventilation tubes, made of plastic, silicon or titanium that are inserted into the eardrum to treat middle-ear infections. They’re also known as tympanostomy tubes.

“Once grommets are in place, they help airflow into the middle ear, so the pressure inside the ear matches the outside air pressure,” explains Dr Sarel van Staden, an otorhinolaryngologist (ENT surgeon) at Mediclinic George, and Mediclinic Geneva.

When are grommets needed?

Dr Van Staden says grommets are commonly used for children who keep getting middle-ear infections or have fluid in their ears that won’t drain. They can be inserted from the age of 10 months. Children are more likely to get ear infections because their Eustachian tubes are shorter and more horizontal, which makes it easier for infections and fluid to build up in the middle ear.

“In children, grommets are mainly used if they get recurrent acute otitis media (middle-ear infections with fluid build-up, also known as glue ear). We use the UK guidelines that recommend grommets for children who have had three or four episodes of otitis media within the space of 6-12 months or if there is chronic effusion (fluid build-up) that needs to be drained,” he says.

If there’s fluid in your child’s ear and they have speech or developmental delays or hearing loss, an ENT may wait up to a month to see if the fluid drains on its own. “The only time a grommet operation is considered an emergency is if a child gets meningitis, acute mastoiditis or a brain abscess from the middle-ear infection,” says Dr Van Staden.

If there are no developmental or speech delays or hearing loss, an ENT may wait up to three months before inserting grommets to see if the fluid drains naturally.

What the grommet procedure involves

Grommets are normally inserted into both ears during a 30-minute operation. Your child is put under a full general anaesthetic in theatre and the surgeon uses an operating microscope.

Dr Van Staden explains that the ENT surgeon will first syringe the ear canal. Then, they will make a small cut in the lower front part of the eardrum to avoid harming nearby structures, like the ossicles (small bone), which help transmit sound from the eardrum to the inner ear.

Before the grommet is inserted, any fluid in the middle ear is drained. Antibiotic drops are put in the ear, and then the same procedure is done on the other ear.

If your child is older than four years or has had a second set of grommets, the ENT surgeon will advise removing the child’s adenoids during the same procedure to reduce the risk of further infections and surgery.

Once awake after the surgery, your child can return home on the same day and is commonly given antibiotics and cortisone drops to use as a precaution for one to two weeks.

Dr Van Staden says young patients are advised not to submerge their ears under water for two weeks after the operation. After this, it’s safe for children to swim wearing a silicone cap, but parents should be on the lookout for any pus leaking from the ear.

Two weeks after the operation, the surgeon will review your child to check that the incision has healed, and that the grommet is still in place. Grommets normally remain in place from six months to two years before falling out naturally as the eardrum closes.

What are the risks?

Dr Van Staden says complications after a grommet procedure are rare and usually don’t affect hearing long-term. However, there are some risks, including a hole in the eardrum, especially if multiple grommets have been used. Other risks include the grommet falling out too early or an infection around the hole that doesn't heal with antibiotics. In very rare cases, a cholesteatoma can form, a growth of skin cells in the middle ear that could cause hearing loss and other issues.

To find an ENT surgeon near you, go to www.mediclinic.co.za