A B C D E F G H I J K L M N O P R S T U V W

INSERTION OF GROMMETS - GLUE EAR

What is the Insertion of Grommets ?

The most common cause of deafness in children is glue ear. This is a condition in which fluid collects in the middle ear and causes a conductive hearing loss. The fluid may vary from thin to very thick sticky glue-like liquid. The condition has a number of different names which reflect the nature of the fluid. These names include middle ear effusion, serous otitis media, secretory otitis media and glue ear, and otitis media with effusion (OME)

How does it occur ?

The middle ear is normally ventilated by a tube which runs into it from the back of the nose. This is called the Eustachian tube. The tube is normally closed and only opens when one swallows or yawns. When the tube opens, air can pass through. This free passage of air keeps the pressure in the ear normal (atmospheric). If the tube does not work well and fails to open, then fluid collects in the ear.

Why does Insertion of Grommets occur ?

The tube has a lining which can swell and block it. Infection and allergy both play a part in causing the swelling. In children, large adenoids may block the opening of the tube. Infected adenoids may also cause poor tubal function, even if the adenoids are small. The Eustachian tubes of children are shorter and fatter than those of adults and are most likely to cause problems. Children are also less immune to infection that the adult. For all these reasons, glue ears are much more common in childhood. Many patients with glue ear have recurrent tonsillitis or nasal allergy or infection. These conditions may contribute to the poor tubal function. Parental smoking is also a risk factor for glue ear in children

Treatment Involved

Medical treatment with decongestants, antihistamines and antibiotics may help the condition resolve. However, antihistamines may cause drowsiness, and decongestants may disturb sleep and alter the child's behaviour. A balloon device which is inflated by the child blowing through his or her nose may be used. This makes the ears “pop” by forcing air through the Eustachian tube. It is not easy to be sure how effective any treatment is, since the condition tends to fluctuate. Depending on the age and the cooperation of the child, hearing tests may be carried out. Young children may not be able to do the ordinary hearing tests. Accordingly, another type of test called impedance audiometry may be done to assess the state of the middle ear. Usually the doctor can detect glue ears simply by looking at them. Glue ear requires surgical treatment if it persists and causes significant deafness for more than 3 months. Then referral to a specialist for insertion of grommets will be advised. The adenoids may also be removed if they are thought to be contributing to the condition. INSERTION OF GROMMETS Grommets are tiny ventilation tubes, which are inserted into the eardrum. This then allows air to pass freely into the middle ear. This keeps the pressure at atmospheric levels and prevents deafness. A grommet is needed when the Eustachian tube is not working properly. No special preparations are needed. The operation is usually done as a day case, under general anaesthetic. Patients must not eat or drink for 6 hours before the operation. Using a operating microscope, a cut (myringotomy) is made in the ear drum and the fluid is sucked out of the middle ear. The grommet is then placed in the cut, so that one end is in the middle ear, and the other end in the external ear canal. Adenoidectomy is often done at the same time, if needed. The patient is usually discharged from hospital a few hours later. Pain is usually very slight, and is treated with paracetamol. Follow up as an outpatient is needed to assess progress. If there is any discharge from the ear, it will repond to ear drops in most cases. On average, grommets can be expected to stay in place for about one year. After the grommets come out, the glue ear problem will recur in about one child in six. Some children will therefore need a second grommet insertion. Fotr this reason, some surgeons use a T-shaped grommet because they wil stay in longer. A disadvantage of using them is that perforation of the drum and infection are more likely. For most children however, only a single insertion is necessary.

After Insertion of Grommets

There is a difference of opinion about how important it is to keep the grommet dry. The prudent will certainly avoid getting soapy water in the ear, but swimming is usually considered to be safe. As a result of the operation, damage may occasionally occur to middle ear structures. If the grommet stays in a long time, it can leave a hole (perforation) in the ear drum. After insertion of a grommet, there can be some scarring of the drum. This is not usually important, but may make re-insertion of a grommet more difficult. Infection of the middle ear occurs in a few cases, but will respond to treatment with drops or antibiotics. Rarely, it may be necessary to remove a grommet, because of continuing infection.

If Left Untreated

Glue ear will persist until there is a return of normal Eustachian tube function. Deafness will persist during this period, which may be prolonged. In a small number of cases, there would be a partial but permanent loss of hearing. This will usually be due to scar tissue forming in the middle ear. Prolonged deafness in childhood may delay speech. As a result, the child cannot communicate well , and may become frustrated. This may result in temper tantrums and other types of disturbed behaviour. The deafness will also slow down the child’s education. This slowness may make people believe that the child is backward. For reasons that are not clear, many children with glue ear are also very clumsy. They may also suffer from repeated earaches amnd infections. If not treated, the condition may linger for years. In the majority of children however, the problem will go away by itself as the child gets older. In a very few cases, a cyst like abnormality will develop, called a cholesteatoma.