What is Glue ear (Otitis media with effusion)?
Otitis media with effusion (OME) is the most common cause of hearing loss in children in the United Kingdom, and up to 80 % of children are affected by OME by 4 years of age at the time when language development is most rapid, and hearing loss has its greatest effect on language development. Glue ear is characterized by a nonpurulent fluid collection in the middle ear that may be either mucoid or serous. The prevalence of otitis media with effusion is highest in those aged 2 years or younger, and it sharply declines in children older than 6 years. Long lasting glue ear (more than 3 months) can cause speech delay, hearing loss, behavioral issues and recurrent middle ear infections. Please refer to the section on glue ear for more details.
What are Grommets?
Grommets are small plastic buttons with a fine hole down the middle. They sit in a hole on the ear drum and are inserted with special instruments using a microscope. They help in ventilation of middle ear and hence are also called ventilation tubes. It has an internal diameter of 1.2 mm.
What is the principle behind grommet insertion?
The principle behind their use is that because your child's middle ear contains fluid which will recur as soon as it is drained out, the only satisfactory form of treatment is to let air into the middle ear. This function, which is normally performed by a special tube at the back of the nose called the eustachian tube, is temporarily impaired in your child, who, as a result, may become hard-of-hearing and may suffer from ear infections. The idea of the grommet, therefore, is to by-pass this tube.
What are the different types of grommets?
Short Term- Shah grommets
Long term- Triune or T tubes
Most of them are made of teflon.
What are the indications for grommet insertion?
Glue ear or Otitis media with effusion (OME)
Recurrent acute otitis media (middle ear infections)
What does the surgery involve?
Grommet insertion is performed under general anesthetic. The surgery takes 10-15 minutes.
The child is sent home after 3 hours. They can go to school after 2 days.
What about post-operative follow up?
I will review child after 2 weeks following a hearing test. If the hearing test shows normal thresholds, then I review them in 6 and 12 months. This is to check if grommets have extruded and to rule out the recurrence of glue ear or presence of ear drum perforation.
How are blocked grommets managed?
This is diagnosed by an ENT specialist. It is unblocked using sodium bicarbonate ear drops.
What are the side effects of grommets?
Ear discharge-This is treated with antibiotic drops. There is no need for oral antibiotics.
Ear drum perforation - The chances of this happening is 6 out of 100. If it persists, then it is repaired through an operation when the child is at least 12 years old.
Scarring of ear drum-Usually doesn't cause any problem.
Can I swim after grommets?
I would advise no swimming for 3 weeks after the operation. After that swimming is allowed. If the child is involved in diving and underwater swimming, I would advise swimming ear plugs (custom made ones).
Can I fly after grommet insertion?
Yes, it is safe.
What happens to grommet after insertion?
They stay on the tympanic membrane for about 9-15 months. After this period of time they migrate outwards from the tympanic membrane and get extruded with the wax. Sometimes grommets itself cause foreign body reactions and persistent ear infections in which they have to be removed.
Will they need reinsertion of grommets?
About 30% of children require grommets to be reinserted. This is because they get a recurrence of glue ear.
What is the role of adenoidectomy in glue ear management?
Adenoids are tonsil like tissues which sit at the back of the nose where the eustachian tube opens. Larger adenoids can block opening and closing of eustachian tube and also harbors biofilm (bacterial colonies) which when infected can cause inflammation in the middle ear along the eustachian tube. Hence removal of adenoids if they are enlarged can help with ventilation and drainage of middle ear. This is usually done if grommets have to be repeated or at the first time itself along with grommets, if child snores and gets frequent upper respiratory tract infections.
What are the things to check after extrusion of grommets?
Recurrence of glue ear
Presence of ear drum perforation
British Medical Journal volume 289 8 December 1984