Operation for Grommets in Children (Myringoplasty)

A myringoplasty to insert grommets is usually a last resort if:

• Your child has continual glue ear or middle ear infection problems
• The Eustachian tube is continually swollen and does not drain
• Antibiotics do not seem to have an effect

A grommet is a small ventilation drain that is inserted into an incision in the ear drum. The purpose of the grommet is to offer a drainage method for middle ear accumulations. If the Eustachian tube is swollen or even infected, grommets will relieve the pressure on the Eustachian tube allowing it to heal on its own and allow the swelling to go down so it can drain the middle ear cavity in a normal manner. Only one grommet is inserted into one ear drum at any one time.

A myringoplasty fro grommet insertion is carried out under a short general anesthetic and takes about 20-30 minutes to complete. Your child will usually be allowed to go home the same day.

Myringoplasty Procedures

A small incision is made in the ear drum. Because there is usually a buildup of pressure from the middle ear, pus and detrius from the middle ear are sucked out of the middle ear chamber with a special instrument and the eardrum is cleaned with an antibiotic solution.  Then a small ventilation drain known as a grommet is inserted into the incision in the ear drum. The grommet looks like a small tube with one end inside the middle ear chamber and the other end outside the ear drum. It is made of either stainless steel or plastic.  Once the grommet is inserted it allows both air into the middle ear space and fluid in the middle ear to drain away through the outer ear canal.

Plastic grommet to drain middle ear fluids

What happens to the grommet in the eardrum?

The grommet slowly moves outwards as the eardrum grows, usually 9 - 12 months. It is then naturally pushed out of the eardrum into the outer part of the ear as the ear drum heals itself. The grommet moves outwards with earwax until it falls out of the ear canal, often unnoticed. Grommets can also easily be removed at a follow-up ENT appointment.

Over half of children who have grommets do not need further surgical treatment as they get older. However, 30% of children will need grommets inserted a number of times until their glue ear condition improves. Although the eardrum is tough, repeated grommet insertions may eventually scar it, which can sometimes cause a hearing loss as the scar tissue makes the ear drum less resilient i.e. less able to vibrate.

Looking after a child with grommets

The hole in the eardrum for grommet insertion is small, however, it is worth taking a few simple precautions to stop water getting into your child's ear:

• Your child should swim on the surface of the water only and not dive.
• Use earplugs or cotton wool with Vaseline to stop soap water getting into the ears when showering or washing their hair.

Flying is actually easier for a child with a grommet. The grommet allows air in and out of the ear as air pressure changes. However, children who have a history of frequent ear infections or have had grommets in the past (but no longer have them) are occasionally at risk of perforation of the eardrum when flying. If you are worried about this, ask your doctor.

About 5% of children with grommets get an ear discharge at some time, often after a cold. This is usually not serious or painful, but it is important to keep your child's ears clean and to consult your doctor as soon as possible. Your doctor will usually prescribe antibiotics or eardrops.

If your child gets a lot of discharge, gently clean their ears using a twist of clean cotton wool or a very soft cloth. Never use a cotton-tipped ear cleaning stick as you may go too far into the ear and cause damage. If infections are treated quickly, the ears will get back to normal with the grommets in place in most children.

Other surgical treatment for glue ear

Other surgical treatment for glue ear involves an 'adenoidectomy' or surgical removal of the adenoids. The adenoids are located above the tonsils, at the back of the throat and are thought to assist the body in its defense against incoming bacteria and viruses by helping the body to form antibodies. With ear infections, the adenoids often swell, usually due to an infection in the immediate area, in this case, the middle ear. However, the reverse is also true. If there is an infection in the throat and the tonsils and adenoids swell, they can sometimes cause a middle or inner ear infection.

Adenoids get larger between birth and four years of age and then become progressively smaller. By adulthood they have disappeared altogether.

An adenoidectomy is commonly carried out in children over the age of three and is thought to help stop a child from getting glue ear again. Removing their adenoids does not harm a child. Adenoids are removed through the mouth under general anesthetic and the child is usually allowed to go home the same day.

How you can help your child with glue ear

If your child has glue ear condition, you can do a number of things to help:

• Make sure your child has been properly assessed by your doctor who may refer you to an ENT specialist.
• If you suspect that an allergy is causing glue ear, ask the ENT specialist about this.
• Avoid smoking near your child.

While waiting to see if glue ear clears up on its own or waiting for grommet surgery, children sometimes have reduced hearing for quite some time and will need help with communication. During this time, they may need to use a hearing aid and have support at home and school. Here are some ways in which you can make communication easier with your child:

• Reduce background noise when talking to your child, for example turn down the television.
• Attract their attention before you start speaking to them.
• Put your head at their level. Do not shout.
• Speak clearly. Do not exaggerate mouth movements.
• Let family and teachers know about the problem.
• Remember that glue ear usually stops being a problem well before puberty.