Grommet insertion at Cardiff and Vale Hospitals

What is grommet insertion?

Grommet insertion is a procedure to treat glue ear, where sticky fluid builds up in the middle ear and stops the eardrum passing sound through properly. A grommet is a tiny tube, often shaped like a cotton reel, placed through the eardrum to let air pass in and out and help the fluid drain.

What conditions does grommet insertion treat?

Grommets are most often used to treat glue ear (otitis media with effusion). This is a condition many children experience, with estimates suggesting roughly 8 out of every 10 will go through it by their tenth birthday. It happens when the Eustachian tube, running between the middle ear and the upper part of the throat behind the nose, doesn't work properly, allowing fluid to build up behind the eardrum.

• discomfort or reduced hearing affecting one ear or both
• children becoming short-tempered, struggling in conversations, or wanting the television louder than usual
• ear infections that keep coming back

In adults, grommets may also be used where fluid behind the eardrum won't clear, for delivering medication into the middle ear for conditions including sudden hearing loss or the inner-ear condition Meniere's disease, or for ongoing Eustachian tube problems, under the guidance of a specialist ear doctor.

What are the benefits of grommet insertion?

Glue ear often clears up on its own, so many people don't need surgery at all, and simpler options, such as wearing a hearing aid or simply waiting to see how things develop, are usually tried first. Where fluid persists and is affecting hearing, fitting a grommet can help restore hearing by letting the fluid drain away and allowing air to reach the middle ear again.

Are there different approaches to grommet insertion?

How the procedure is carried out can vary depending on your age and circumstances:

• under a general anaesthetic, so you're asleep throughout the procedure, which is the usual approach for children
• under a local anaesthetic instead, which numbs the ear so you stay awake; this is more common in adults, and tends to be carried out as an outpatient appointment rather than a hospital stay
• in adults, a grommet can also be used to deliver medicine, steroids or a specific antibiotic among the options, directly into the middle ear for particular conditions

What happens before grommet insertion?

Because glue ear often improves without treatment, doctors will usually want to see that it's persisted for some time before considering surgery, and may try a period of watchful waiting, a hearing aid, or a device to help ventilate the ear first.

For children, this typically means fluid and reduced hearing affecting both ears for 3 months or longer, confirmed twice with a 3-month gap, or a pattern of 6 or more ear infections within a twelve-month period where fluid persists. For adults, an effusion that's persisted for 6 months or more, with noticeably reduced hearing in the affected ear, is generally expected before grommet insertion is considered as a way of dealing with the fluid by itself.

Enlarged adenoids, the tissue tucked up behind the nose, can contribute to glue ear, and children sometimes have these removed during the same operation as having grommets fitted.

What happens during grommet insertion?

1. You're given either a general anaesthetic, so you're asleep, or a local anaesthetic to numb the ear while you stay awake.
2. Your surgeon reaches the eardrum through the ear canal, magnifying the view to see clearly, and makes a small opening in it.
3. Any fluid behind the eardrum is removed using suction.
4. A small plastic or metal grommet is placed into the opening.
5. Drops that combine an antibiotic with a steroid may be given to help prevent infection.

Both sides can be sorted in the same visit, with the whole procedure usually wrapped up in around 20 minutes.

What does recovery look like?

Grommet insertion is usually done as a day case, meaning you're able to head home again on the same day. If you've had a general anaesthetic, you'll first spend time coming round in a recovery area under close supervision.

Earache is possible afterwards, though many people feel little or no pain. Taking Paracetamol can help if needed but speak to your team about pain relief options after surgery to keep you comfortable. Most people are back to their usual routine within a day or two. Avoid swimming initially and speak to your team about when you can resume swimming. Keeping water out of your ear in the shower, a cotton wool plug coated in Vaseline works well for this, can help prevent infection.

A follow-up appointment, often booked for around 6 weeks later, will check where the grommet has settled. A grommet usually stays in place somewhere between 3 months and a year, sometimes longer, before it's pushed out naturally as your eardrum heals.

What are the risks and complications?

Possible risks of grommet insertion include:

• an infection developing in the middle ear, generally straightforward to treat
• a small hole left behind in the eardrum once the grommet falls out, usually healing by itself but occasionally needing a further procedure
• a small scar on the eardrum, which doesn’t usually affect hearing
• the general risks that come with any surgical procedure, including those linked to anaesthesia, which your surgeon will discuss with you beforehand