Grommets
Grommets are tiny ventilation tubes placed in the eardrum to help air reach the middle ear. They are most commonly used in children with persistent glue ear causing hearing loss, but they can also help selected children with recurrent acute ear infections. The aim is to improve hearing, reduce the build-up of fluid behind the eardrum, and in some cases reduce how severe repeated infections become.
I have performed hundreds of grommet procedures, and an important part of my role is making sure surgery is actually the right option before proceeding. That means a careful assessment of the ears, hearing, symptoms, and the wider underlying cause of the problem. I also assess the ear carefully during surgery itself to ensure the most appropriate treatment is carried out.
A grommet operation is usually a short day-case procedure. In children, it is usually performed under a general anaesthetic. In adults, it can sometimes be performed under local anaesthetic. I make a very small opening in the eardrum, remove any fluid if needed, and place the tiny tube into the opening so the middle ear can ventilate properly. In children, grommets typically stay in place for around 6 to 12 months before they fall out naturally as the eardrum heals, although sometimes they come out sooner and occasionally they stay in for longer.
In adults, there are also different types of grommets to consider, depending on the underlying ear problem, how long ventilation is likely to be needed, and the condition of the eardrum.
Why might a child need grommets?
The commonest reason is glue ear that has lasted long enough to affect hearing and day-to-day life. This may show up as reduced hearing, unclear speech, difficulty listening, needing repetition, turning the television up, or concerns from nursery or school.
In some children, grommets may also be helpful for recurrent acute otitis media, particularly where infections are frequent, painful, or associated with repeated fluid build-up behind the eardrum.
How do grommets work?
A healthy middle ear needs air. If the Eustachian tube is not working properly, the middle ear can fill with fluid and the eardrum cannot move as well as it should. Grommets allow air to pass through the eardrum, helping to equalise pressure and improve ventilation of the middle ear. That can improve hearing and reduce the feeling of blockage caused by fluid behind the eardrum.
What are the benefits of grommets?
For the right child, grommets can:
improve hearing
help clear persistent middle ear fluid
reduce the effect of glue ear on speech, listening, and school life
reduce the build-up of pressure and fluid during some ear infections
make future ear infections easier to manage in selected cases
The main benefit is usually greatest in the months after insertion.
Do grommets always need to be inserted?
No. Not every child with glue ear or repeated ear infections needs surgery. Many children improve naturally with time, which is why observation is often the right first step when symptoms are mild.
Other options may include observation, hearing support, hearing aids in selected cases, or addressing contributing factors such as enlarged adenoids. Otovent may also help some children who are old enough to use it properly.
Might a child need an adenoidectomy at the same time?
Sometimes, yes. Enlarged adenoids can be a root cause of poor middle ear ventilation because they sit close to the Eustachian tube opening. In some children, particularly where glue ear is persistent or there are associated symptoms such as nasal blockage, mouth breathing, or snoring, I may advise addressing the adenoids as part of the overall treatment plan.
In some children, a tonsillectomy may also need to be considered as part of the wider picture. For example, if a child has significant sleep-disordered breathing/ obstructive sleep apnoea as well as enlarged adenoids and ear problems, treating the tonsils may also be important.
What happens on the day of surgery?
Grommet insertion is usually performed as a day-case procedure. The actual operative time is short, often around 10 to 15 minutes, but the overall time in theatre is longer because it also includes the anaesthetic, safety checks, preparation, and recovery.
Before inserting the grommet, I examine the ear carefully under the microscope. If there is wax present, this is removed first so that the eardrum can be assessed properly. I then carry out a detailed microscopic examination of the eardrum before making a tiny cut, removing any fluid, and placing the grommet into position. Most children go home the same day.
What are the main risks of grommets?
Grommet surgery is common and usually straightforward, but it does carry risks. These include:
a small amount of bleeding
ear discharge or infection after surgery
the grommet falling out earlier than expected
the grommet staying in longer than expected
blockage of the grommet
a small scar on the eardrum
a small hole in the eardrum that does not close after the grommet comes out
the possibility that hearing or ear symptoms do not improve as much as hoped
In some children, further surgery may be needed later if glue ear returns, if the grommets come out and the problem recurs, or if a persistent perforation remains in the eardrum.
What is recovery like?
Recovery is usually quick. Most children are back to normal activities very soon after surgery, and many return to nursery or school the next day or shortly afterwards. After the operation, children are usually not aware that the grommet is there and no daily maintenance is normally needed.
Are there any water precautions?
For the first 2 weeks after surgery, it is sensible to try to keep water out of the ears. A simple way of doing this is to place cotton wool coated in Vaseline in the outer ear during bathing or hair washing. Extra care is sensible with soapy water, as this can pass through the grommet more easily than plain water.
After 2 weeks, swimming is usually fine, but diving should be avoided.
What if my child gets an ear infection after grommets?
A child can still get an ear infection after grommets, but the pattern is often different. Instead of pressure building up painfully behind the eardrum, the infection may come out through the grommet as ear discharge. When infections happen with grommets in place, children often have less pain and fever, and treatment is usually simpler, often with antibiotic ear drops rather than oral antibiotics.
If there are recurrent infections after the grommet has been inserted, I may occasionally need to consider removing the grommet, although this is rare.
Will hearing be checked again afterwards?
Yes. A post-operative hearing test will usually be arranged to confirm that hearing has improved as expected and to check that the grommets are functioning properly.
What happens when the grommet falls out?
In many children, the grommet falls out on its own and this may not be noticed at all. Sometimes it can become stuck in ear wax in the ear canal before eventually coming away.
Once the grommet has come out and the eardrum heals over, the original symptoms can sometimes return. A small number of children therefore go on to need a further set of grommets.
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Disclaimer
This page is intended as general information only. It does not replace a consultation, examination or individual medical advice.