All you need to know about grommets

16 May 2014

One of the most common operations performed on children is the fitting of grommets. But when does your child need to have this operation and what are the implications? We get specialist advice.

Having grommets inserted into your child’s ear is one of the most common operations moms have to deal with. These tiny tubes not only offer relief from frequent middle-ear infections, but could also help prevent more serious complications such as brain damage. Our panel of ear, nose and throat (ENT) surgeons insist the procedure is quick and painless. They also give some answers to other frequently asked questions.

When should a child get grommets?

“Children should get grommets when there’s a recurrent ear infection or persistent fluid, mucus or pus in the middle ear,” Dr Ismail Khaleel, an ENT surgeon from Johannesburg, says. Children who get more than three ear infections a year could benefit from grommets.

Why should you have the operation done?

Grommets ventilate the middle ear artificially by allowing air in, explains Dr Azgher Karjieker, an ENT surgeon from Cape Town.

Children who don’t get grommets when necessary are at risk of eardrum perforation, hearing loss, as well as frequent inner-ear infections, says Dr Khaleel.

Other rare, but serious complications of recurring ear infections include mastoiditis (inflammation of air cells in the skull behind the ear), meningitis (inflammation of the membranes surrounding the brain or spinal cord) and brain abscesses.

What’s more, your child could miss out on hearing and speech development opportunities because they’re hearing impaired, adds Dr Martin Young, an ENT surgeon from Knysna.

What does the operation entail?

Dr Young explains, “The child is put to sleep by an anaesthetist. The surgeon uses a microscope to examine the eardrum, and then makes a 3 mm hole in it.

“He then sucks out any fluid from the middle ear, and places a grommet – a small tube about the size of a match head with flanges on either side – in the hole to stop it from closing.

“This hole replaces the function of the faulty Eustachian tube (the tube that equalises pressure on either side of the eardrum). Grommets are also known as ventilation tubes, because they allow air back into the middle ear and immediately improve hearing.”

What are the risks?

Dr Young says any anaesthetic or surgery carries risk, but in the case of grommets the procedure is relatively quick and low risk.

“In rare cases the grommets can fall out too soon, fall into the middle-ear cavity, or leave a small hole in the eardrum when they do fall out. Occasionally the body reacts to the presence of a grommet and the area becomes inflamed and may leak, requiring the grommet to be taken out. These are all minor risks relative to the benefits of the surgery.”

Is it painful?

In extremely rare circumstances it can be painful enough that it has to be removed, but more often than not it’s less painful than the condition it’s treating, says Dr Khaleel. “[The procedure] is actually a pain relief,” he adds.

How long do grommets stay in the ear?

It depends on the type of grommet, but those commonly used last between eight months and a year before they fall out, says Dr Khaleel. “We rarely need to take these out ourselves,” he adds.

After several sets of grommets, an ENT might offer longer-term grommets or T-tubes, which stay in for longer, says Dr Young.

Can kids swim with grommets in their ears?

“A child with grommets should avoid putting his head under the surface of dirty or soapy water, for example the bath, public pools, rivers or dams,” Dr Young says. “Diving under the surface without earplugs must be avoided. This is to stop water going through the grommet into the middle ear where it will cause pain and possible infection. Earplugs can be specially made for the child by an audiologist, or bought from a pharmacy. Be careful of Prestick and silicon wax plugs because these can get stuck in the ear canal and require another general anaesthetic for removal. No other activities pose problems.”

-Petro-Anne Vlok

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