Everything you need to know about grommets for kids

If your child is suffering persistent ear infections, it may be time for grommets. Here is what you’ll want to know about these tiny tubes.

Ear infections are a common and painful part of childhood but typically clear up within 10 days.

For the unlucky few, however, they can become chronic, causing not only distress but also affecting a child’s hearing.

In these cases, a medical expert may recommend treatment using a tiny device called a grommet.

Here is what you need to know about these curiously named ventilation tubes.

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What are grommets?

Ear, Nose and Throat (ENT) surgeon Dr Janitha Jayawardena says a grommet is a small tube that measures a few millimetres in size.

He says grommets allow the middle ear – located behind the eardrum – to equalise with the ear canal by letting air in, and help to drain away fluid.

“As a result of ear infections, fluid can build up and become trapped,” Dr Jayawardena, of Melbourne ENT Group, explains.

This can lead to temporary hearing loss, which can cause delays in speech and language development.

“But the procedure releases that fluid and when the child wakes up, their hearing is back to normal,” Dr Jayawardena says.

“Having a grommet in place means when a child gets sick with another virus, that fluid has a pathway to get out.”

What ear conditions are treated by grommets?

Grommets are most used as a treatment for children under the age of five but can be recommended for older kids and, in rare cases, for adults.

ENT clinical nurse consultant Jodie Ballantine, of Queensland Children’s Hospital, says they can treat a number of ear conditions, including recurrent middle ear infections in children who have experienced three or more episodes in six months.

They can also be used to treat glue ear –  a build-up of thick fluid behind the eardrum –  especially when linked to hearing loss, speech delay or eardrum damage.

“Grommets will improve hearing in the majority of children with glue ear that is causing a conductive hearing loss,” Jodie says.

“This has been shown to improve speech and language outcomes, and may tackle some behavioural issues that are associated with glue ear.”

Jodie says for children with recurrent middle ear infection, grommets may reduce the frequency and severity of infections but won’t eradicate them.

Families can discuss whether grommets are appropriate for their child with their GP, audiologist or specialist ENT doctor.

How are grommets inserted into the ear?

An ENT surgeon uses small instruments with a microscope to make a tiny hole in the eardrum, clear any fluid and place the grommet into the hole to keep it open.

The surgery is typically performed under a general anaesthetic, but some adults may only need a local anaesthetic.

Dr Jayawardena says in most cases, children go home after the procedure without needing pain relief.

“Parents will seldom complain that children have any pain from a grommet,” he says.

“With any surgical procedures there’s always risk of complications, which must be discussed with parents beforehand.”

How are grommets removed from the ear?

Dr Jayawardena says grommets are designed to be pushed out by the eardrum over a period of six to 18 months.

In some rare cases, they need to be surgically removed under anaesthetic.

“The ENT surgeon will then make an assessment as to whether the child needs another grommet, or if they have grown out of the condition that caused the problem in the first place, which is often eustachian tube dysfunction,” Dr Jayawardena says.

“About a quarter of children need a second or a third grommet.”

Can you swim with grommets?

The answer is yes – but it’s not cut and dried.

Jodie says doctors will advise if a child needs to use ear putty or plugs to keep their ears dry during swimming but “most children do not need to take any special water precautions”.

Dr Jayawardena says advice can vary in Australia but, generally, diving should be avoided, and ear plugs or putty should be used in waterways such as lakes, rivers and dams.

“The answer can depend on which ENT surgeon you ask; most will adopt conservative advice around keeping the ears dry,” he says.

“But not all toddlers like wearing ear plugs, and (they) are not always very good at keeping them in.”

Can you fly with grommets?

Not only can children fly with grommets in place, these devices are also likely to make for a more comfortable experience, Jodie says.

“Their grommets will equalise their ears, instead of having to ‘pop’ their ears when they fly,” she says.

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Written by Elissa Doherty.