Grommets / Ventilation Tubes / Tympanostomy Tubes
Grommets are small plastic tubes that sit in the ear drum. They allow air to get from the outer ear to the middle ear, and therefore dry any secretions in the middle ear. They are used to treat Glue Ear and recurrent Acute Otitis Media, as well as some other conditions.
What does surgery involve?
Grommet surgery in children usually needs a general anaesthetic. The anaesthetist will see you on the day of surgery and explain the anaesthetic to you. The surgeon will use a microscope to magnify the view, and use small instruments to pierce the ear drum and create space for the grommet. They will the insert the grommet into the hole that has been created in the ear drum. The rest of the ear drum tightens around the grommet, and holds it in place.
The outside of the ear drum is made of skin, and like the skin elsewhere it is constantly shedding. That means that the ear drum will gradually push the grommet out. Once the grommet is out, the ear drum hole that the grommet was in usually heals by itself. Usually grommets stay in about 6 months, but there is a lot of variation.
Some grommet types (for example T-tubes or permavents) stay in for much longer. This might seem attractive, but the problem with tubes that stay in longer is that the risk of complications also increases. Therefore, we usually use grommets that last about 6-9 month, as this is seen to be striking a good balance between stay time and complications.
What about the complications then?
Majority of the time surgery goes well, bit there are a few things to be aware of.
Sometimes there can be bleeding from the ear after surgery, usually this settles quickly. If you do notice any bleeding after you have been discharged from the hospital please seek medical attention.
Some children get an infection. You will recognise this because of ear discharge. If it happens, please seek medical attention as treatment with antibiotic drops may be needed. Usually, there is no or little discharge from the ears once you have been discharged from the hospital
We have already said that grommets get pushed out after a period of time. Sometimes, once they come out, the hole in the ear drum left by the grommet doesn't heal, and your child may be left with a perforated ear drum. Contrary to what you might think, this may cause very few problems! Have a look at the section on perforated ear drums also.
Once the grommet is out and the ear drum heals, we hope that the glue ear doesn't come back. But sometimes glue ear returns, and this may lead to the same problems that the child had before grommets were put in. If this happens, your child may need grommets again. Overall, about a quarter of children have to have grommets again within two years of the first surgery, and up to half of all children treated will end up having grommets more than once. So there is a very real chance that grommets may not be a one-off procedure for your child. It's OK to have grommets 2 or 3 times, but if glue ear still keeps coming back then often we reach a point where we are concerned that further surgery may weaken the ear drum, and we recommend hearing aids instead. Of course, the parents themselves also get fed up of repeat surgery and it is not unusual for parents to look for solutions other than grommets.
Getting Grommets on the NHS
Grommets are no longer routinely funded by the NHS. This means that NHS will only fund them in specific circumstances. For the most part, what is funded is what matters, but there are a few quirks! Different regions apply different funding criteria, so here is a general guide to help you understand what is funded. But remember, the internet isn's a replacement for medical advice, and your own region may have different criteria. Please talk to your doctor.
Grommets for Glue Ear are recommended and funded when hearing loss is present, which makes sense: why would you want to have surgery if the hearing is actually normal! Also, hearing loss has to be on both sides: again, children with one-sided hearing loss usually manage quite well (see Glue Ear page), so it makes sense to avoid surgery unless it is an only option. The hearing criteria don't apply to recurrent Acute Otitis Media.
You have to have had Glue Ear for 3 months at least. This makes sense, because we know that in many cases Glue Ear gets better quickly. However, you have to have had your Glue Ear confirmed by an audiologist or ENT specialist. This means that your 3 month clock doesn't start ticking UNTIL you have seen audiology or ENT. It can be frustrating if you have waited a long time before seeng audiology / ENT, only to then discover that you have to wait another 3 months from when you first meet them. So the sooner you see audiology or ENT, the sooner your clock starts ticking. If you have access to audiology in your area and you can self-refer, we would strongly encourage you to do that as this means that you get hearing tested, the diagnosis is made, and your 3 month watchful waiting period starts. Also, there is little point in a second visit before 3 months, as you need to have two tests 3 months apart. On the other hand, do remember that for most children's Glue Ear does just resolve, so if it's not a major problem then just waiting is perfectly reasonable.
Remember, your GP, ENT specialist and audiologist have not made these rules, and may well disagree with them. If you have concerns, you need to raise them with your local Clinical Commissioning Group, the body that decides what NHS pays for in your region.