Glue Ear: Guide

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Grommets

A grommet is a small ventilation tube that is surgically inserted into the eardrum to ventilate the middle ear.  The insertion of grommets for the treatment of Glue Ear is one of the most common operations performed under general anesthetic in childhood (Department of Health 2015).  Glue Ear normally resolves itself so guidelines state that there should be a 3 month period of persistent Glue Ear before surgical intervention should be considered.

The child is admitted into hospital and the operation is performed under a general anaesthetic.  A small incision is made in the eardrum and the fluid is removed. The grommet is inserted to allow air into the middle ear.

eardrum grommet in situ

 

The grommet will fall out after a period of time and the eardrum will heal.  This can be from 6-12 months, sometime longer in an older child (Robb & Kubba 2015).  Once the grommet has come out it is possible that the fluid will return and so another set of grommets may be required.  It is not advisable for the grommet insertion to be repeated more than 3 times as it can cause some scarring to the eardrum (Robb & Kubba 2015).

photo grommet for scale - on finger tip and against UK penny

This YouTube link shows an ENT Surgeon explaining Glue Ear and grommets.

NICE guidelines for grommet surgery in under 12s have been published by the National Institute for Health and Care Excellence (NICE) in 2008.

The Guidelines (NICE 2008: 12) state that:

  • 1.4.1 Children with persistent bilateral OME documented over a period of 3 months with a hearing level in the better ear of 25–30 dBHL or worse averaged at 0.5, 1, 2 and 4 kHz (or equivalent dBA where dBHL not available) should be considered for surgical intervention.

Professional judgement can be made in exceptional circumstances (NICE 2008: 13)

  • 1.4.2 Exceptionally, healthcare professionals should consider surgical intervention in children with persistent bilateral OME with a hearing loss less than 25–30 dBHL where the impact of the hearing loss on a child's developmental, social or educational status is judged to be significant.

The guidelines (NICE 2008: 10) with regard to children with cleft palate state that: 

  • Insertion of ventilation tubes should be offered as an alternative to hearing aids in children with cleft palate who have OME and persistent hearing loss.                                

Grommets have the benefit that the impact is instant and children sometimes report that they can hear better.  Parents may notice that their child’s speech becomes clearer. Grommet insertion does however require a general anaesthetic and it can become blocked in some cases quite quickly, resulting in the fluid returning.

For a child with an underlying sensorineural hearing loss who is a hearing aid user, grommet insertion can result in more ear infections.  It is likely to be more appropriate to manage the additional conductive loss by increased amplification.

A child should not go swimming for 2 weeks after grommet surgery.  After 2 weeks, in most cases, they can swim in chlorinated pools without ear protection, however they should not jump in from a height or go down to the bottom of the pool. 

Children should avoid getting soapy bathwater in their ears at bath time and when hair washing.  Cotton wool soaked in Vaseline can be used to stop water getting in.

Information about how Glue Ear is treated with grommets.

The NDCS have prepared a comic book for children about a boy who gets grommets

NHS information Clinical Guidelines

 

References

Department of Health (2015) ‘NHS reference costs 2013-2014’ [Accessed: 27 May 2021]

Hall, A., Maw.A., Steer,C., (2009) Developmental outcomes in early compared with delayed surgery for Glue Ear up to age 7 years: a randomised controlled trial.’ Clinical Otolaryngology Vol 34 Issue 1 pp 12-20

National Collaborating Centre for Women’s and Children’s Health, Commissioned by the National Institute for Health and Clinical Excellence; 2008. ‘Surgical management of otitis media with effusion in children.’ London (UK) [Accessed: 27 May 2021]

National Institute for Health and Care Excellence (2008) ‘Otitis media with effusion in under 12s: surgery.’ [Online] Available at: https://www.nice.org.uk/guidance/cg60/resources/otitis-media-with-effusion-in-under-12s-surgery-975561238213 [Accessed: 27 May 2021]

Robb, R and Kubba, H (2015) ‘About grommets’. ENT UK, The Royal College of Surgeons of England. [Online] [Accessed: 27 May 2021]

Simpson, S., Thomas, C., van der Linden, M., MacMillan, H., van der Wouden, J., Butler, C. (2007) 'Identification of children in the first four years of life for early treatment for otitis media with effusion'  Cochrane Library [Online] [Accessed: 27 May 2021]

 

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