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Grommet Insertion

 
     
 

What is it?

First of all, each ear is made up of three parts. There is the outer ear which you can see, and which gathers the sound. Further in, the outer ear runs into the middle ear on each side. Deeper still, there is an inner ear on each side. The sound goes down the ear tube, which is part of the outer ear, into the middle ear on that side. The ear drum stretches across the deepest part of the ear tube between the outer ear and the middle ear. The drum is about a third of an inch (0.8cm) across. It is made of thin skin, like the top of a real drum. The middle ear is an air space which connects with the back of your nose. This is why your ear drums pop when you blow your nose. Fluid has built up in the middle ear, because it cannot drain through to the back of your nose. To start with, the fluid was thin and watery. Gradually, it has become thick and sticky, like jelly. It is sometimes called "glue ear". This fluid stops the ear drum letting the sound through properly. It is the cause of your hearing difficulties. The fluid behind the ear drum may be also leading to infection in the middle ear.

The Operation

You will have a general anaesthetic and will be completely asleep. The surgeon will shine a very fine microscope down your ear tube. He will make a tiny cut in the ear drum (myringotomy). A very fine sucker will be placed through the hole in the eardrum into the middle ear.

The sucker will draw the fluid from behind the ear drum like a miniature vacuum cleaner. He will then plug a tiny hollow plastic tube into the hole in the ear drum. This tube is called a grommet. It is shaped like a cotton reel with flanges that hold it in place in the ear drum. The grommet lets air pass from the ear tube through the ear drum and into the middle ear. Any fluid in the middle ear will now just dry up. Because you will be asleep, you will not feel any pain during the operation. Your operation can be done as a day case. The surgeon can do both sides at the same time if needed.

Any Alternatives

If you leave things as they are, the fluid will probably not drain away. The hearing difficulties will continue. You may get serious middle ear infection. This can eventually lead to more and more thickening of the ear drum as well as thickening of the fluid in the middle ear and can cause an irreversible hearing loss. Tablets, medicines, nose drops, and inhalers, will no longer help. Hearing aids are only a stop gap. Drawing the fluid out with a fine needle has not helped. The fluid may have just built up again. The fluid may be too thick for needling. You do not need to have your tonsils or adenoids taken out.

Before the operation

Stop smoking and get your weight down if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation. Sort out any tablets, medicines, inhalers that you are using. Keep them in their original boxes and packets. Bring them to the hospital with you. On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared and that you can have the operation as safely as possible. Please tell the doctors and nurses of any allergies to tablets, medicines or dressings. You will have the operation explained to you and will be asked to fill in an operation consent form. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.

After - In Hospital

There is very often no pain in the ear after a grommet operation. The nurses will give you some medicine to take any discomfort away. With the grommet in place, the fluid will clear from behind the ear drum within six to eight weeks. Once the fluid has cleared, you should be able to hear normally. The grommet stays in the ear drum for about a year. As the fluid problem gets better, the hole in the drum heals, and squeezes the grommet out into the ear tube. The grommet then usually sticks to wax in the ear tube. The doctor in the outpatient clinic can then easily take it out. Sometimes the grommet has to be taken out with a small operation, if it does not come out by itself. A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. The nurses will help you with everything you need until you are able to do things for yourself. Do not make important decisions, drive a car, use machinery, or even boil a kettle during this time. Hospitals usually arrange a check-up about one month after you leave the hospital. The nurses will advise about sick notes, certificates etc.

After - At Home

(1) Keep the ears dry. (2) Do not allow water to enter the ears when you are taking a bath or washing your hair. Protect the ear by placing a piece of cotton wool rubbed in Vaseline in the ear. (3) It is better not to go swimming while the grommet is in place. The risk is that dirty swimming pool water will pass through the grommet and cause a middle ear infection. This could make the grommet come out sooner than it should. It is best to wait until the grommet has come out before swimming again. You should not risk the need for more ear operations. (If you must go swimming, plug the ear with cotton wool rubbed in Vaseline, and wear a swimming cap pulled well down over the ears. Do not jump in, dive, or swim under water.) (4) You must not have your ear syringed if you have a grommet. It would be very painful and could cause serious infection in your middle ear. You should be fit to go back to work the second day after your operation. You should be fit to drive one or two days after the operation. It is perfectly safe to travel by air. Air can pass freely through the grommet into the space behind the ear drum, so there will be no problems with changes in pressure.

Possible Complications

As with any operation under general anaesthetic, there is a very small risk of complications related to your heart and lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.

The operation is successful in about 70% of patients. The remaining 30% might need the grommet re-inserted on one or more occasions. If you follow the advice listed above, the grommet is unlikely to cause you any problems. Occasionally people notice a popping or clicking in the ears. This is not harmful and is expected and you should not worry about it.

You may notice some clear but lightly blood-stained fluid coming out of the ear for the first two days after the operation. This is expected but if it continues for more than two days and you get a runny ear (especially if the fluid coming out is thick, yellow and/or green or smelly), it probably means that germs have passed through the grommet and have caused an ear infection. You should go to your doctor who will probably give you antibiotics. If the infection is not getting better, he will arrange for you to be seen in the ENT outpatient clinic. In a few patients, the ear can be a bit runny without anything serious being wrong. In addition, if you don’t have a runny ear but you get a headache, a temperature or you become irritable, you should also be alert and ask for medical advice because these symptoms can be an indication of a developing infection.

There is a 2 to 3% chance that following the insertion and removal of the grommet (especially after multiple insertions and removals as can be the case sometimes) the ear drum will develop a hole that doesn’t heal well. Given time most of these holes heal on their own but for some of them another operation is needed to close them..

 
     
   
 
 
   
     
 
   
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