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[ by Eimear Vize www.irishhealth.com]
What are grommets?
What is the Eustachian tube?
When are grommets recommended?
What causes glue ear?
Can grommets cause discomfort?
Are grommets placed in one or both ears?
Do grommets cure the glue ear for good?
Is there an improvement in hearing?
Some common concerns after grommets are put in
How are grommets removed?
A grommet is a plastic tube (ventilation tube) shaped like a miniature cotton reel, about 2mm in diameter. It is fitted through a small cut in the eardrum (myringotomy). The tension of the eardrum grips and holds the grommet. The cotton-reel shape stops it falling in or out, like a shirt stud in a buttonhole.
The grommet allows air to pass through the eardrum, which keeps the air pressure on either side equal. Provided the grommet remains in position and is not blocked, the hearing returns to normal almost immediately. The surgical insertion of grommets is now one of the most common childhood operations in Ireland.
The Eustachian tube connects the middle ear with the back of the nose. To hear normally, the eardrum and ossicles (three tiny bones in the middle ear) must be able to move easily. For this to occur, the middle ear must contain air at the same atmospheric pressure as the outer ear.
Air in the middle ear comes from the back of the nose, via the Eustachian tube. The job of the Eustachian tube is to ventilate the middle ear, keeping the pressure in the middle ear the same as in the outer ear. Most middle ear diseases, including glue ear, are associated with poor Eustachian tube function. The health of the middle ear depends on the Eustachian tube working properly.
The insertion of grommets may be recommended for persistent glue ear (longer than three months).
We are not exactly sure what causes glue ear, but doctors believe it is connected to the Eustachian tube not functioning properly. The Eustachian tube usually keeps the air pressure on both sides of the eardrum equal. If the tube is blocked, this causes the air pressure inside the middle ear to drop. Fluid drains from the surrounding tissue to fill up the middle ear. With time, this fluid becomes sticky and stops the eardrum and ossicles vibrating as they should.
Once grommets are inserted, the child is usually completely unaware of their presence. If the child does complain of any discomfort it should be reported as soon as possible.
If a child has a history of repeated severe infection in both ears, then the infection will need to be drained from each ear and so he will have grommets placed in both. However, there is no known medical reason for a child to receive grommets in both ears if he only has a history of infection in one ear.
When the grommet falls out the problem with glue ear is usually gone. However, sometimes the fluid returns after the grommet falls out and the eardrum heals over. A repeat operation to put a new grommet in is sometimes needed. In some children a grommet is needed several times until glue ear clears for good.
In 99% of cases where grommets have been inserted there is usually a dramatic improvement in hearing.
Swimming is usually fine. However, it is best to avoid underwater swimming or ducking the head deeply underwater. Some surgeons advise wearing earplugs when swimming. Always follow any specific advice about swimming from your surgeon.
Try not to get soapy water into the ears. Don't duck the head into soapy water. Wash the outside of the ears in the normal way. A cotton wool ball with Vaseline placed in the ear canal could be used to prevent water from getting into the ear.
Flying in a plane is actually easier if you have a grommet in your ear. The grommet allows the pressure of air to equalise between the middle and outer ear. This prevents ear pain during landing and take off.
How are grommets removed?
Grommets will usually fall out of their own accord after a number of months and the child will not even be aware that this has happened. If they do not fall out spontaneously within 18 months, they will be removed by the ENT surgeon in a simple and painless procedure. The tiny hole left in the eardrum after the removal of grommets will then heal itself.