THE NITTY GRITTY ON GROMMETS

HEMA THAKOR of Oticon South Africa, the first company to launch a fully digital hearing device, explains the ins and outs of this operation

Grommets are tiny plastic (or metal) tubes that are surgically inserted into a child’s eardrum (tympanic membrane) and therefore maintain an open channel between the outer ear and middle ear space. When a child has an ear infection, the tube between the inner and outer ear (the Eustachian tube) gets inflamed, which causes fluid to build up behind the eardrum. As this fluid leaves the outer ear it does so through the eardrum, and it often happens that the eardrum bursts in the process. Sometimes the fluid doesn’t drain from the ear at all once the infection has cleared up. If there is fluid in that area, it will flow out through the grommet into the outer ear. The grommets also allow air into the space behind the ear drum and reduces the risk of fluid building up in that area.

WHY WOULD MY CHILD NEED GROMMETS?

This is dependent on each individual child, so consultation with an ENT on the matter is most important. A child would generally need grommets if they are experiencing chronic middle ear infections for three to six months or recurrent middle ear infections (three infections in six months or four infections in a year). There is no right age to have the op done either, but the period that children are generally more prone to developing middle ear infections is between six months and two years, mostly because of the size and shape of the Eustacian tube. What’s more, up to seven years of age is a crucial stage for language acquisition and development, and chronic ear infections can hamper that (because hearing is affected). So if the ear infections persist during this phase and they are being negatively affected, there is greater motivation to perform the surgery.

ARE GROMMETS JUST A POPULAR PLACEBO OR DO THEY REALLY WORK?

Grommets do really work. However, an ENT will often first try to manage the ear infections and their consequences in the form of medicine before opting for grommet insertion. They may try this for a short or long period of time depending on the cause and progression. Only once medical management is proven to be unsuccessful, will they consider grommets.

WHAT CAN PARENTS EXPECT DURING THE OP?

The procedure itself usually takes about 20 minutes, depending on how much cleaning needs to be done to the ear. Add in a period of time for the child to go to sleep and then to wake up after the anaesthetic, and you’re looking at less than one hour in theatre. As a parents you’re allowed to accompany your child into the operating room while the anaesthetist puts him to sleep, usually using inhalational anaesthetic (a mask where after a few deep breaths, the child goes to sleep). At this point you’re asked to wait either in the ward or a nearby comfort room while the procedure is being done. Following the procedure and depending on the anaesthetic used, it usually takes a child anything up to one hour to wake up and be able to eat and drink something but within a few hours you and your child will be on your way home.

WHAT ARE THE POSSIBLE RISKS INVOLVED?

The risks during the surgery are minimal and rare, including a small amount of bleeding from the ear drum, especially if there is a significant amount of middle ear inflammation at the time.

AND THE CHANCES OF MY CHILD DEVELOPING AN INFECTION?

The ear infections may continue after the grommet has been inserted, but the grommets will allow the discharge to drain more easily out of the middle ear and so the chances of extreme sensations of pain and fullness are lessened. Due to the fact that the grommets also allow the middle ear to be aerated, the infections also clear up much faster.

WILL MY CHILD NEED REPEAT GROMMETS?

It is impossible to say if your child will require grommets again because it depends on the underlying cause for their insertion in the first place. If they have been inserted for glue ear and have no nasal symptoms then re-insertion is unlikely, but in a very young child with allergic rhinitis, for example, then repeat grommets may be needed. This is always decided on a patient by patient basis.