Introduction
The lining of the middle ear keeps itself moist by making a watery fluid. Sometimes, this fluid becomes thick and gluggy, like glue. It can become too thick to pass through the eustachian tubes that connect the ears to the back of the throat. This thick fluid builds up in the ear, causing infection and hearing loss.
Glue ear will usually get better on its own. Glue ear that has not gone away by three months may need to be treated with grommets.
Grommets are small tubes that are inserted into the ear to help fluid drain out.
Some other names for grommets are:
- ventilation tubes
- drainage tubes
- Shepard's tubes
- collar button tubes
- t- tubes.
It is important not to leave glue ear untreated, as it can cause hearing loss and issues with learning and development.
Preparing for the procedure
Grommets are inserted during a procedure in the hospital. Your child will be under a general anaesthetic for the procedure, meaning they will be asleep and will not feel any pain.
The hospital will contact you to tell you:
- what time your child needs to arrive at the hospital
- what time your child needs to stop eating and drinking
- what your child will need to bring along for their stay.
Inserting grommets is usually a day procedure, which means your child can go home a few hours after the procedure is finished.
During the procedure
In the procedure to insert grommets:
- a tiny cut is made in the eardrum
- trapped fluid is suctioned out
- grommet tubes are inserted to allow air into the middle ear.
Once air can enter the middle ear, the tiny bones and eardrum that create hearing will be able to move again. Your child's hearing should improve immediately after the procedure.
Sometimes, your child's adenoids are also removed during the procedure to help improve the drainage out of the ear. Adenoids are glands in the throat that sit behind the nose.
After the procedure
Your child should be able to go home a few hours after the procedure, depending on how they feel when they wake up.
For 1-2 days after the operation, your child may have a slight ooze or bleeding from the ear.
Contact your doctor if your child has discomfort, pain or fluid coming from the ear for more than five days after the procedure.
Grommets will fall out of the eardrum after 6-12 months. This will depend on the grommet's size, shape and material and the shape of your child's ear.
The hole made in the eardrum will heal quickly after the grommet tubes fall out.
Ear fluid may build up again, even after grommets. If this happens, you will need to take your child back to their doctor for follow-up.
Management
Ear plugs
Ear plugs help make sure that dirty water does not get into the ear until the grommets have fallen out and the eardrum has healed.
Some common ear plugs used after grommets include:
- cotton wool smeared with Vaseline
- custom made ear plugs from hearing aid suppliers
- soft plastic ear plugs- available from your local pharmacy
- silicone ear putty - available from your local pharmacy
- blu-tack.
If you use ear putty or blu-tack, make sure you use a piece as big as your child's outer ear so it does not get stuck in the ear canal.
Hygiene with grommets
Your child must avoid getting water in their ears until the grommets have come out of the eardrum and the eardrum has healed. Grommets will usually fall out after 6-12 months.
Showering is usually easier than bathing to avoid dirty water getting in the ears. If your child wants to have a bath, make sure it is very shallow, and their head does not get wet.
Use earplugs when washing your child's hair to stop water and shampoo from getting in their ears. You can also try washing their hair in the hand basin or using a shower attachment.
Swimming with grommets
Your child cannot swim for a week after the operation. They should not dive when swimming, as the water's pressure and force can cause ear pain and infection.
Ear plugs should be used when swimming anywhere other than the ocean. Ear plugs can be kept in place with a swimming cap or an ear wrap-type headband.
While grommets are in, keeping dirty water out of the ears is important to avoid infection.
'Dirty water' includes:
- bath water
- heated pools
- spas
- rivers
- lakes
- dams
- creeks.
What to do when water gets in the ear
If your child gets water in their ears while the grommets are in, there is a risk of developing an infection.
If your child develops an ear infection, they may need medicated ear drops or antibiotics from their doctor.
Your child should not swim until the infection is gone.
Hearing tests after glue ear and grommets
Your child should have their hearing tested soon after the grommets have been inserted. They will need to have their ears checked regularly to see if the grommets are still in the eardrum and still working.
Hearing tests for children are available at:
- some hospitals
- community health centres
- audiologist clinic
- ear, nose, and throat (ENT) specialist’s clinic.
Children under four need specialised testing, which your child's doctor can organise.