Grommets (Ventilation tubes)

What are grommets?

Grommets resemble very small plastic washers (just over a millimeter in size) that are inserted into a hole made in the  eardrum to stop the hole from closing. This helps the middle ear to 'breathe' by equalising the pressure in the middle with that of room air and allows fluid from the middle ear to drain out. 

When is grommet insertion helpful?

Some of the more common reasons for placing grommets are mentioned below:

Hearing loss due to fluid behind the eardrum

In normal circumstances a tube connects the middle part of the ear with the back of the nose. This tube helps the pressure in the middle ear (the space containing the auditory ossicles which are the small bones of hearing) to equalise to the same pressure as the environment that you are in and is called the Eustachian or Auditory tube. Equalisation occurs by the tube opening which occurs when we swallow or yawn and also when we 'pop our ears' such as when we ascend and descend in a plane. 

When the Eustachian tube does not open, pressure equalisation does not occur. Initially, this may be noticed as a blocked ear sensation. Sometimes, inflammation within the tube that occurs after an infection such as the common cold or blockage of the opening of the tube can cause the Eustachian tube to remain closed for longer periods. This can lead to fluid being secreted by the lining of the middle ear walls which in turn can cause further hearing loss. This is one of the more common causes of hearing difficulty in children and is termed otitis media with effusion (OME).

Recurrent ear infections

Middle ear infections can occur frequently in some individuals and especially children. These can cause all the symptoms of an infection such as being unwell and feverish. However, middle ear infections can be especially painful as owing to the build up of pressure associated with an infected fluid behind the ear drum. 

Will having grommets stop ear infections?

When grommets are in place, they may not reduce the frequency of infections but they may help to reduce the pain that can occur with middle ear infections. 

What does grommet insertion operation involve?

You will need a recent hearing test before undergoing a grommet operation.

Grommet insertion is more often performed through the ear canal under general anaesthesia. In some cases Dr Michael undertakes this procedure under local anaesthesia where you are awake but medicines are used to numb the ear.

A small hole (myringotomy) is made in the ear drum. Fluid present behind the ear drum is then cleared using a small suction apparatus. As this hole can heal very quickly, a grommet is placed to keep the hole open and keep the pressure in the middle ear equalised. 

Are there any risks to having grommets?

Grommets may sometimes increase the frequency of ear infections. If infections do not settle with medicines, the grommet may need to be removed.

After the grommet has fallen out, the ear drum heals over. However, in about 1% of cases this does not happen and a hole is left. If appropriate, this hole can be repaired with a relatively straightforward operation.

How will I feel after the operation?

There is usually no pain involved and people typically go home the same day if they have had a grommet operation without any associated procedures. However, if you have other procedures such as the removal of your tonsils and adenoids, you may require an overnight stay.

Are there any precautions that I should undertake?

Having a grommet has minimal restrictions. You can swim but should not dive into the water or swim deeper than 2 meters depth. For the first week after the operation, aim to keep soapy water out of your ears.

Do I need to have the grommets removed?

Most grommets that are inserted are designed to pushed out by the eardrum and consequently fall out by themselves. This can happen anywhere between a few months and a few years after they have been placed. Often, as they are so small, people don't notice when they fall out. Dr Michael will review you after the operation on a regular basis until the grommets have fallen out. He will discuss the merits of removing them if they have not fallen out after a few years. 

Occasionally, grommets can increase the rate of infections and may then need to be removed earlier than planned.