Having grommets fitted

Published by Bupa’s Health Information Team, December 2010.

This factsheet is for parents of children who are having grommets fitted, or who would like information about it.

Grommets (also known as ventilation tubes) are tiny plastic tubes fitted into the eardrum. The tube lets air pass in and out of the ear and is used to help treat glue ear.

You will meet the surgeon carrying out the procedure to discuss your child’s care. It may differ from what is described here as it will be designed to meet your child’s individual needs.

How the ear works

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About grommets

Fitting grommets in your child’s ears can help treat glue ear. The tubes let air pass into the ear and stop fluid collecting. The middle ear is able to work normally and your child can hear clearly again.

Glue ear is common in children between the ages of four and seven. It occurs when fluid and mucus collect in the middle ear behind the eardrum. It can make it difficult for your child to hear properly and, as a result, can cause delays in speech and language development.

The middle ear

The middle ear is behind your eardrum. It contains three tiny bones that move when sounds reach them. These transmit sound waves through your middle ear to your inner ear. For the ears to work properly the middle ear needs to be kept full of air. This is enabled by the tube that connects the back of the throat to the middle part of the ear (Eustachian tube).

                                           The outer, middle and inner ear

What are the alternatives?

Your doctor may suggest ‘watchful waiting’ with several hearing tests before recommending treatment. Your doctor may suggest having grommets fitted if your child has problems with his/her speech and language. An alternative to having grommets is the use of hearing aids, but this isn’t commonly recommended.

Preparing for having grommets fitted

The operation is usually done as a day case. This means your child has the procedure and goes home the same day.

If your child has a cold or infection in the week before the operation, please let the hospital know. The operation may need to be postponed until your child has fully recovered.

Grommets are usually fitted under general anaesthesia. This means your child will be asleep during the operation. Typically, he/she must not eat or drink for about six hours before a general anaesthetic. Often the operation will be planned for the morning, so that your child will only have to miss breakfast. Most anaesthetists will allow your child to have water for up to two hours prior to surgery but you should check with your hospital.

At the hospital, a nurse will ask you questions about your child’s general health and check your child hasn’t had anything to eat or drink.

You must tell the nurse about any allergic or unusual reactions to medicines your child may have had in the past and about any history of bleeding problems in the family.

The surgeon will usually visit your child before the operation. The surgeon will discuss with you what will happen before, during and after your child’s procedure, and any pain he/she might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form. You will be asked to sign a consent form if you have parental responsibility for the child.

What happens during having grommets fitted

The operation takes 15 to 30 minutes.

Once the anaesthetic has taken effect, the surgeon will make a small cut (about 2mm) into the eardrum and use a fine tube to draw out the fluid. The grommet is then fitted into the ear. Both ears can be treated during the same operation.

Antibiotic and steroid eardrops may be put into the ear to help prevent infection and swelling.

What to expect afterwards

Your child will need to rest until the effects of the anaesthetic have passed. Your child will be groggy, and may feel or be sick.

Your child may need pain relief to help with any discomfort as the anaesthetic wears off. The surgeon will usually prescribe painkillers for a day or two.

Your child may be prescribed a course of antibiotics.

The nurse will give you some advice about caring for your child’s ears before you go home. You may be given a date for a follow-up appointment.

Recovering from having grommets fitted

If your child is prescribed antibiotics, it’s important to complete the whole course.

If your child needs pain relief, you can give your child over-the-counter painkillers such as paracetamol or ibuprofen syrup (eg Calpol or Calprofen). Always read the patient information that comes with the medicine and if you have any questions, ask your pharmacist for advice. Do not give aspirin to children under 16.

Your child should stay at home for a day or two to minimise contact with possible infections at school. Also keep your child away from crowded and smoky places, and from people with coughs and colds.

Follow your surgeon’s advice about swimming and bathing. Your surgeon may recommend that your child doesn’t swim for at least two weeks and wears earplugs when he or she resumes swimming. You mustn’t let your child dive into water.

Soapy water can slide through the tiny hole in the grommet more easily than plain water. When washing your child’s hair, you should place some cotton wool in his/her ears and cover it with petroleum jelly (eg Vaseline) to make a waterproof barrier.

Call your GP if you have any concerns or if your child develops any of the following symptoms:

• a fever – a temperature higher than 37.5°C
  
• worsening pain
  
• sticky discharge from the ear
  
• bleeding from the ear

What are the risks?

As with every procedure, there are some risks associated with having grommets fitted. We have not included the chance of these happening as they are specific to your child and differ for every person. Ask your surgeon to explain how these risks apply to your child.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure, for example feeling sick as a result of the general anaesthetic. Side-effects of having grommets fitted include:

• mild earache
  
• blood-stained discharge from the ear

Complications

Complications are when problems occur during or after the operation. Most children are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic.

Complications specific to having grommets fitted are uncommon but can include:

• infection – antibiotics may be needed to treat ear infection
  
• no effect – the operation may not improve your child’s hearing significantly
  
• persistent ear discharge – the grommet may need to be removed
  
• eardrum fails to heal – rarely, further surgery is needed to close the hole after the grommet falls out

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.