Does your child suffer from glue ear or frequent ear problems? They might need grommets. Dr Graeme van der Meer of Auckland children’s ENT explains more.
Ear problems are a regular occurrence for many children, and often discussion around hearing loss or ear infections turns to grommets. Grommet insertions are one of the most common surgical procedures performed worldwide. In New Zealand, approximately one in every 12 to 15 children will benefit from grommets.
What are grommets?
Grommets, also known as ventilation tubes, are small plastic or metal tubes which get placed into a child’s eardrum, usually while they are asleep under anaesthetic. The purpose of a grommet is to allow air to enter the middle ear and equalise pressures. Usually we are able to do this through our eustachian tube and a simple blocking one’s nose and a gentle blow fixes any pressure changes we may experience. In children however, there are various factors which make their eustachian tubes not work as effectively as adults, which predisposes them to problems with their middle ears. A classic scenario is the crying child on an airplane. As the plane starts descending, the little one starts complaining of painful ears in the only way they know how by crying loudly. While adults are able to equalise the pressure by themselves, many children are unable to, resulting in an exquisitely painful and noisy landing.
How does a grommet work?
Grommets work by ventilating the ear and breaking the vacuum that forms inside the middle ear. Imagine a glass of water with a straw in it. If you were to put your finger on the top of the straw and lift it out of the glass, a column of fluid would remain inside the straw. The instant you lift your finger off the top, the water falls out and the straw is drained. This is exactly how a grommet works, allowing the pressure to equalise and any fluid inside to be drained through the eustachian tube.
What predisposes children to need grommets?
We know that the majority of children don’t have very good eustachian tube function, and this is something that they will grow into as they get a bit older. Usually, however, they are able to self-resolve the occasional blocked ears that they may get. It’s important to note that all children of two to six years in age will, at some stage, have a blocked ear, and the occasional ear infection is also considered to be par for the course. It is only when children experience significant or ongoing problems with their ears that an intervention is required. Certain conditions (such as cleft palates) may predispose children to getting grommets.
Why would my child need grommets?
There are many international studies available on the indications for grommets, and consensus revolves around two different factors. The first one is ear infections: If your child has more than three infections in six months or six infections in one year, grommets should be considered. The other, more insidious, need for grommets is that of a chronic blocked ear. This is a condition in which fluid builds up in the ear but it never becomes infected. What it does do is cause the ear to be blocked, sounds to be muffled and, occasionally, the eardrum itself to be adversely affected. So-called “glue ear” or serous otitis media is not unusual in children, but could cause problems if left untreated for more than three months. Children’s hearing is a very important avenue for their learning and subsequent speech development, and if a child’s hearing is suboptimal over a long period of time, this has significant effects on their learning and speech. Another potential clue for parents for blocked ears is a child who is more clumsy than his or her peers, as middle ear fluid buildup causes balance to be affected.
How are grommets inserted?
After a meeting with an Ear, Nose, and Throat (ENT) Specialist where the need for grommets will be discussed, the procedure usually involves a general anaesthetic. Although it is not a painful procedure, it is very difficult for children to lie still while having something poked into their ears and, for this reason, a quick anaesthetic is preferable. Once the sedative is given, the ENT could make use of large cotton swab to get rid of the earwax. As soon as the earwax is cleaned out of the child’s ear, a small (3mm) incision is made in a safe part of the eardrum, fluid is removed, and the grommet is inserted. This results in an immediate relief and improvement in the child’s hearing.
What if the fluid was drained and a grommet not inserted?
This would still create an instant improvement in hearing, but after two or three days, once the drainage site has healed, the problems would return. The goal of a grommet is to allow ventilation of the ear to happen for the lifespan of that grommet (usually between six and 12 months).
Grommet insertions are one of the most common surgical procedures performed worldwide.
What happens to a grommet after this period?
The vast majority of grommets are naturally extruded from the eardrum in a painless process which sees the eardrum heal over thereafter. This usually buys enough time for the child to have outgrown the underlying problems which have led to the ear infections in the first place. Approximately one in every four children who have had grommets may need a second set of grommets.
How can a grommet be checked once it’s in?
Once the grommet is inserted, your GP or ENT Specialist is able to see it by looking into the ear with special equipment. As a family, you may notice an immediate improvement in hearing and resultant improvement in speech, and far fewer ear infections.
What if my grommet doesn’t come out by itself?
If a grommet stays in for more than two to three years and is felt to no longer be necessary, it can be removed. Sometimes this can be done in the off ice, and sometimes this may require an anaesthetic.
Can my child swim with grommets?
The short answer to this is yes! Swimming in clean water is fine, and has not been linked with an increased risk of infections, based on very recent studies. Occasionally, children may find that soapy water may be a bit uncomfortable, in which case your ENT surgeon would recommend using an earplug or some cotton wool in the ears when bathing or washing your child’s hair.
Do all children with blocked ears need grommets?
Fortunately not; the child’s ears need to be assessed and the cause of the blockage confirmed. If it’s something simple as wax, this can be removed and grommets are not needed. If there is short-lived fluid in the ears, this can also be treated with watchful waiting. Should there, however, be ongoing blockage of the ears (more than three months) or recurrent infections, then grommets are necessary. Antibiotics, antihistamines, steroids, nasal decongestants, homeopathy, and acupuncture have not been shown to be of any benefit in children with blocked ears and recurrent ear infections.
What do I do if I’m concerned about my child having lots of ear infections or not being able to hear very well?
A good first step would be to consult with your GP. He or she would have a look into your child’s ears and decide if they do need referral to an ENT specialist for review. Hearing tests can also be performed. These are routinely done before school to remove any concerns about hearing issues which have not been noted.
Dr Graeme van der Meer is a Paediatric ENT specialist based in Auckland. He is a consultant at Starship Children’s Hospital with special interests in airway and breathing disorders, sinus problems, and head and neck lumps. Graeme also has rooms in Epsom and Mairangi Bay.