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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Grommets

What are grommets?

Grommets, also known as tympanostomy or ventilation tubes, are tiny plastic tubes that are inserted into a small slit in your child’s eardrum, under general anaesthetic (The Paediatric Society of New Zealand & Starship Foundation, 2005-2010).

 

Why are grommets necessary?

Many ear disorders result in a fluid build-up in the cavity of the inner ear, mostly due to infection or inflammation. Normally this fluid is able to drain out through the Eustachian tube, which is a narrow canal connecting the middle ear to the back of the throat. The Eustachian tube is responsible for balancing the air pressure either side of the tympanic membrane. If this tube gets blocked, it is unable to ensure balanced air pressure nor provide an outlet for the accumulated fluid and mucus in the middle ear. As a result, the eardrum may bulge, or if the middle ear pressure becomes too low, the eardrum may become inverted. In either case, the eardrum’s flexibility to vibrate with sound is adversely affected and the three small bones of hearing – namely the anvil, hammer and stirrup – are unable to transmit vibrations effectively. This decreased ability is evident in a loss of hearing and even deafness in some children (Health i Talk, 2010).

 

In general, grommets are recommended for cases of glue ear that won’t clear up, or if your child suffers from frequent bouts of acute otitis media (see section on Ear Infections for further information). The following can be used as a guideline:

·                Glue ear or a thick glue-like mucus that is present in the middle ear for more than 3 months, and is affecting your child’s hearing ability and subsequently his speech and language development and/or learning.

·                6 acute middle ear infections, over a 1-year period, especially when both ears are affected.

·                Repetitive ear infections throughout the summer months, when these infections should be less likely to occur.

·                Previous complications as a result of ear infections (Collins, 2003; Health i Talk, 2010; The Paediatric Society of New Zealand & Starship Foundation, 2005-2010).

 

Why do children suffer from ear infections more frequently than adults?

·                Children are more prone to infections in general due to the underdevelopment of their immune systems, i.e. their immune systems are still learning to fight infections and until they are able to do so effectively, usually around age 5 or 6, your child is likely to catch whatever bugs are going around.

·                Children are more vulnerable to ear infections due to anatomical considerations. A child’s Eustachian tube is shorter and narrower and is in a more horizontal position than an adult’s. This means that the immature tube is unable to drain effectively, resulting in blockage due to mucus accumulation or swelling. When fluid is unable to drain away from the middle ear, it provides a perfect breeding ground for bacteria. Also, the 3 tiny bones or ossicles, are unable to move freely in order to transmit sound from the eardrum to the inner ear if the middle ear cavity is filled with fluid, resulting in mild, reversible hearing loss.  Fortunately, from the age of 8 your child is less likely to suffer attacks of otitis media because as they grow, so do their Eustachian tubes (Little Helper Healthcare).

 

Middle ear infections are the biggest cause of earache in infants and children, with up to 75% experiencing at least 1 bout of otitis media before the age of 3. Signs that your child may be experiencing pain in their ears include ear tugging, loss of balance, and fever and a discharge. The resultant hearing loss may be evident in your child’s lack of a normal response when spoken to, irritability that is generally worse at night or when your child is lying down. Generally, viral URTI, such as the common cold or flu, is responsible for the fluid build-up described above, but allergies to food, pollen, animal dander, dust, etc and environmental toxins such as fumes and cigarette smoke, may do the same. Bacteria may sometimes be the direct cause of otitis media but a bacterial infection mostly enters the warm, moist environment of the middle ear, following a viral infection or allergy which was the original culprit. Once a bacterial infection is present, it turns what might have once been only inflammation into infection, causing your child to develop a fever (Little Helpers Healthcare).

 

How to help your child if he is experiencing hearing difficulties

·         Speak clearly and give your child sufficient time to reply.

·         Make sure your child can see your face when you speak to him.

·         Call your child’s name, wait for him to look at you and then speak.

·         Ensure that your child’s teacher is aware that he is experiencing hearing difficulties.

·                If your child is of school-going age, it may be helpful for him to sit at the front of the class (The British Association of Otorhinolaryngologists, 2003-2004).

 

What do grommets do?

Grommets bypass the ear’s own ventilation system or the need for clear and functioning Eustachian tubes by providing a tiny canal between the middle and outer ear. Once they have been inserted into your child’s eardrum, grommets act like a plug with a minute hole that allows air and fluids to travel from the middle to the outer ear. This ensures a balance in air pressure and removes any difficulties that may hinder the movement of the eardrum and the bones of hearing. Grommets buy time, by performing the functions of the Eustachian tubes, until these tubes become bigger and are able to function more effectively (The Paediatric Society of New Zealand & Starship Foundation, 2005-2010).

 

How long do grommets last?

Grommets are designed to remain in your child’s ear for approximately 6 months to 2 years, after which time they fall out naturally and the eardrum closes up. In a small percentage of cases, a second set of grommets may be necessary. When this occurs, the specialist will look into the possibility of inflamed and infected adenoids being the source of the blockage or recurrent infections, if this has not been done already. Adenoids are lymph glands that are responsible for producing infection-fighting cells. They are situated near the throat opening of the Eustachian tube, are larger in childhood and generally shrink in size as your child gets older. Other signs of an adenoidal obstruction include nasal speech, open-mouth breathing and snoring. Your ENT may decide to perform an adenoidectomy when the second set of grommets is inserted (Leary, 1990; Little Helpers Healthcare).

 

Who will perform the operation and what is the procedure?

A specialist ENT surgeon, also known as an otorhinolaryngologist or ORL surgeon, will perform the operation. On the day of the surgery, your child will be admitted to hospital for approximately half a day. Before the operation, nurses and doctors will see you and your child. If you have any concerns, mention them at this time. Under a brief general anaesthetic, a tiny cut is made in the eardrum. This procedure is called a myringotomy. In the case of glue ear, the thick glue-like substance is sucked from the middle ear. A grommet is then placed in the eardrum. Grommet surgery usually takes 10-15 minutes (Birmingham Children’s Hospital, 2005; The Paediatric Society of New Zealand & Starship Foundation, 2005-2010).

 

After the operation

Your child will be given painkillers in theatre. He may experience some discomfort for 24-48 hours after the operation. Liquid paracetamol, in appropriate doses, may be given if necessary (ensg, 2003).

 

Some parents notice an immediate improvement in their child’s hearing and it is common for children to think everything sounds too loud. It will take a few days for them to get used to having normal hearing again. Your child may return to school or nursery the day after the operation (The British Association of Otorhinolaryngologists, 2003-2004).

 

 Some children develop a discharge from their ears after grommets have been inserted. This is usually not painful and is easily treated with ear drops. Contact your GP in this regard (The Paediatric Society of New Zealand & Starship Foundation, 2005-2010).

 

What are advantages and disadvantages of grommets?

 

Benefits

If grommets are inserted for the correct reasons, there are great advantages and few drawbacks.

·                The insertion of grommets usually improves your child’s hearing and frees him from the pain and discomfort of earache.

·                Grommets buy time, so that as your child grows, the size and function of the Eustachian tube should improve and ear problems should decrease.

·                Grommets can have an impact on your child’s overall development. Persistent glue ear and chronic otitis media, can impair your child’s hearing temporarily at a time that is crucial for speech and language development. Ear disorders may result in unexplained personality changes, especially during a cold or following an ear infection, and result in a persistently cranky or ill-tempered child. Children who are particularly badly behaved and inattentive may be misdiagnosed as having ADD when they are actually experiencing hearing difficulties, and/or are not getting enough quality sleep due to snoring and breathing difficulties associated with enlarged adenoids. Grommets restore hearing quickly and prevent potential delays in development.

·                Grommets prevent acute ear infections and inflammation from progressing to more serious states that require drug therapy and more invasive procedures. For example, untreated infections can cause necrosis of the surrounding ear tissue, resulting in tinnitis (ringing of the ear) or deafness (Birmingham Children’s Hospital, 2005; ensg, 2003; Health i Talk, 2010; Leary, 1990; Little Life Healthcare).

 

Possible complications

It is rare for there to be serious long-term adverse effects following grommet surgery. However, grommets have become controversial because in some cases their insertion is abused when they are placed too soon. There are now clear indications for when grommet surgery is necessary and they should not be placed unless your child has a 3-month treatment history. Although grommets are a low-risk procedure, any procedure involving a general anaesthetic holds potential risks.

·                A watery or thick, gluey discharge may develop after grommets have been inserted. This is sometimes referred to as a runny ear. Treatment involves prescription ear drops or oral antibiotics.

·                If the discharge is chronic, the grommet may extrude, leaving a perforation. If this happens, the hole may have to be repaired surgically when your child is older, usually around 8-10 years of age.

·                Scarring of the eardrum, known as tympanosclerosis.

·                Weakening of the eardrum resulting in retracting pockets.

·                Rarely, grommets fail to expel themselves and need to be removed under general             anaesthetic.

·                Occasionally a grommet may block. If this happens, your doctor may prescribe ear drops to help clear it.

·                Some children require more than one set of grommets. In recurrent cases of glue ear, long-stay grommets with long flanges may be inserted because they retain the grommet in the ear for longer periods of time (Birmingham Children’s Hospital, 2005). ensg, 2003; Little Life Healthcare). 

 

Alternative treatments

Grommets are not the only therapy. Oral antibiotics and corticosteroids may be necessary. Some doctors may use a steroid nose drop or spray to see if they help. The alternative to grommet surgery is for your child to wear a hearing aid to amplify any sounds to the ear (Birmingham Children’s Hospital, 2005; The British Association of Otorhinolaryngologists, 2003-2004; Health i Talk, 2010).

 

Ear grommet care and precautions

·                It is advisable to wear ear plugs when swimming, bathing, showering and shampooing in order to prevent possible ear infections and the resultant discharge.

·                Surface swimming is allowed after the first two weeks.

·                It is essential that dirty or soapy water does not enter the ear. As an alternative to ear plugs, cotton wool covered with Vaseline may be placed in your child’s ears when bathing or showering.

·                Dry the external ear thoroughly after swimming or bathing.

·                Children with grommets should experience no problems on an airplane.

·                Jumping and diving are contra-indicated as this can force water into the ear (EarHelp, 2000-2010; ensg, 2003)

 

See also:

http://www.healthtalk.com

http://www.entuk.org

http://www.kidshealth.org.nz

http://www.paediatrics.org.nz

http://starship.org.nz

http://www.littlelife.co.za

http://www.earhelp.co.uk

http://www.ensg.co.nz

www.bch.nhs.uk