What is it?
The grommet in your child's ear drum has done its job. There is no more fluid behind the ear drum in the middle ear. The ear is now healthy again. Most grommets come out on their own. Some grommets, like your child's, are slow to come out. It needs to be taken out with a little operation.
Diagram © Copyright EMIS and PIP 2005
The operation
Your child will be given a short, general anaesthetic and will be completely asleep. The surgeon will shine a microscope into the ear. He will pull the grommet out of the ear drum with a special instrument. Because your child is asleep, there will be no pain during the operation. The operation can be done as a day case. This means that your child comes into hospital on the day of the operation and goes home the same day. When the grommet is out, there is a small hole left in the ear drum. This will usually close up on its own. The surgeon will check your child's ear drum in the outpatient clinic after about six weeks, to make sure that it is has done this.
Any alternatives
If you leave things as they are, the grommet may stay there for years. It could be difficult to get out if the delay is long. All the time the grommet is in place, your child must not get water in the ears. Swimming and especially diving are not safe unless the ears are protected with ear plugs and a tight bathing cap. Your child cannot have the ear syringed to remove any wax. There is no rush to have the grommet taken out. But your child would be better off without it.
Before the operation
Your child must have nothing to eat or drink for about six hours before the operation (clear fluids and water up to 2 hours before, breast milk 4 hrs). Your child's stomach needs to be empty so that the anaesthetic can be administered safely. If your child has a cold in the week before admission to the hospital, please telephone the ward and let the ward sister know. The operation will usually need to be put off. Your child has to get over the cold before the operation can be done because by having an anaesthetic the cold could turn into a serious infection in the chest.
Sort out any tablets, medicines, inhalers that your child is using. Keep them in their original boxes and packets. Bring them to the hospital with you. On the ward, your child may be checked for past illnesses and may have special tests to make sure that he or she is well prepared and can have the operation as safely as possible. Please tell the doctors and nurses of any allergies to tablets, medicines or dressings. You and your child will have the operation explained to you and you will be asked to fill in an operation consent form. Many hospitals now run special preadmission clinics, where you and your child visit for an hour or two, a week or so before the operation for these checks.
After - in hospital
Usually there is little pain after this operation. If there is any discomfort in the ear, paracetamol in liquid form should easily control it. A general anaesthetic may make your child slow, clumsy and forgetful for about 24 hours. While in hospital, the nurses will support you to help your child until he or she feels better. Before you leave the ward, the nurses will give you an appointment to come to the ENT (ear, nose and throat) outpatient clinic in six weeks or so for the surgeon to check your child's ear drum. The surgeon in the outpatient clinic will tell you if the hole in your child's ear drum has healed. He will let you know if it will be safe for your child to swim again without any special protection for the ear.
After - at home
After three to four hours on the ward, your child should feel fit enough to go home. The doctors will check that your child's ear is comfortable and is not bleeding. It is important that your child still keeps the ear dry. Any water in the ear may go through the hole in the ear drum and cause an infection. Plug the ear with a piece of cotton wool rubbed in Vaseline at bath times, or when washing your child's hair. He or she should not go swimming unless the ear is properly protected with ear plugs and a tight bathing cap. Use a painkiller such as paracetamol suspension every six hours to control any pain in the ear.
Possible complications
As with any operation under general anaesthetic, there is a very small risk of complications related to the heart and the lungs. The tests that your child will have before the operation will make sure that he or she can have the operation in the safest possible way and will bring the risk for such complications very close to zero.
If you follow the advice given above, you are unlikely to have any problems. There is a very small risk that your child's ear may bleed when you get home. If this happens, come back to the ward. There is also a very small possibility for an ear infection. If this happens, you will notice some fluid coming out of the ear (with a bad infection this can be thick, green and or yellow and smelly) and your child might have a headache or temperature. The infection usually settles by taking antibiotics for a week or so.
In 2 to 3% of children, the small hole in the ear drum may not close up after six weeks. Given more time, most of these close on their own without any treatment. A few need to be closed with another operation.
The grommet insertion operation is successful for 70% of children who have it. The remaining 30% may need a grommet reinserted on one or more occasions because fluid builds up again at a later date.
General advice
These notes should help you and your child through the operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little. If you have any queries or problems, please ask the doctors or nurses.
