(Tuesday, 30th Sep, 2014)
A grommet is a plastic tube which is slipped through a tiny incision in the eardrum. It acts as a pressure-equalisation tube for the child providing a temporary, extra Eustachian tube to allow bacteria and fluid to drain from the middle ear.
The surgical insertion of grommets is now one of the most common childhood operations in Ireland.
The external opening of each ear leads, by a short passage, to the eardrum. On the other side of the eardrum is a small chamber or compartment known as the middle ear. The middle ear is connected to the base of the throat by a long passage called the Eustachian tube. Beyond the middle ear lies the inner ear and this contains a large number of delicate and complicated structures which affect both hearing and balance.
Grommets have been in widespread use in Ireland and England since around 1954 when they were hailed as being a major breakthrough in the fight against recurring ear infections in children. The surgical procedure to insert them is both simple and safe and the child usually suffers no ill-effects whatsoever.
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.
In recent years, doctors have seen more and more cases of a condition which is medically called secretory otitis media, but is commonly known as glue ear. This is thought to be related in some way to the widespread practice of children being given courses of antibiotics for middle ear infections, many of which are unnecessary for viral infections and are not completed once the child appears to recover from the infection.
Before the use of antibiotics became so common, any acute infection of the middle ear would have led to a burst eardrum and a runny nose. This would have allowed the sterile accumulation of glue to drain from the middle ear.
With antibiotic treatments this gluey stuff builds up in the middle ear and, while it is not always necessarily infected, it becomes trapped and can cause partial deafness in children.
Where the glue becomes trapped in a childs ear, the only way of relieving the pressure on both sides of the eardrum and improving the hearing is to place grommets into the eardrum. These give the childs Eustachian tube an extra boost by helping to drain any bacteria and fluid which has become trapped in the middle ear.
The thick gluey substance which has built up in the middle ear will not drain through the tiny grommet but what the grommet does is act as an air tube to relieve pressure on either side of the eardrum.
In 99% of cases where grommets have been inserted there is usually a dramatic improvement in hearing. Many parents find it hard to believe that the grommets are merely air tubes and that the accumulation of thick, gluey stuff in the middle ear has not been surgically removed.
There is no hard and fast rule on this. Some children with grommets are advised not to swim or to go underwater in the bath, while others are allowed to swim with ear plugs and are advised to exercise caution. If in doubt, ask your doctor.
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.
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