The insertion of middle ear ventilation tubes (grommets) is one of the most common operations performed on children.

 

Mr Russell will have discussed the indications for the surgery. This operation is recommended for children who have a hearing problem due to a persistent fluid collection in the middle ear. It may also be suggested as a treatment for recurrent middle ear infections.

 

At the time of the operation, further surgery may be performed, such as adenoidectomy or tonsillectomy.

 

Admission will be on the day of the surgery. Once in hospital, the routine admission procedures will take place, involving interviews with nursing staff. This will provide the information necessary for comfort and medical care.

 

The anaesthetist will visit to explain the form of anaesthetic to be used.

 

The trip to the operating theatre will be with a nurse and a parent (if wished), ending by meeting one of the operating room nurses, and the anaesthetist. The anaesthetist will then commence the anaesthetic using the method that was explained previously.

 

THE OPERATION

 

Using a microscope the ear drum is identified and a small opening is made and any fluid is removed from the middle ear with suction. A grommet is then placed into the opening.

 

The grommets are generally made of a plastic-like material. The most common types are in the shape of a cotton-reel with a central channel.

 

AFTER THE OPERATION

 

Once awake, there will be little, if any, pain. Sometimes a dull ache is described, but this is easily relieved by analgesics, usually Paracetamol.

 

Some discharge, clear or blood-stained, may appear in the ear canal. This is of little concern and can  just be wiped clear.

 

The child may notice an immediate improvement in the hearing.

 

When the nursing staff are satisfied that the child has fully recovered from the anaesthetic, the child will be permitted to return home, usually about 2-4 hours after the operation.

 

COMPLICATIONS

 

1. Discharge

A clear discharge (often blood stained) may be noticed to come from the ear in the first few days. This should dry up spontaneously. If the discharge recurs or the ear becomes painful, please contact Mr Russell as antibiotics may be required.

While the grommets are in place discharge from the ear may occur. This is usually in association with an upper respiratory infection and will settle within a few days. If it persists, please contact Mr Russell.

 

2. Early loss of grommet

In a small number of cases the grommet falls out of the ear-drum much earlier than expected. This may occur due to an early infection. The problem will be managed as necessary.

 

3. Blockage of the grommet

The grommet may become blocked with blood in the first week which will be checked at the first post-op visit.

 

QUESTIONS COMMONLY ASKED

 

Can my child commence swimming lessons?

There is generally no reason to limit the normal childhood activities. Plugs should not usually be required when swimming, bathing or showering. If uncomfortable, the ear can be plugged either with a fitted plug (such as "Pro-Plug") or "Blu-Tack".  Putting the head under the water in the bath or spa pool is to be avoided because of potential contamination and risk of infection.

 

How long do the tubes last?

Most grommets will stay in place for 9-12 months, although on occasions longer term tubes are required. You may notice the grommet come out,but, it is quite small and may be missed.

 

What happens if the grommet falls out too early?

Sometimes Mr Russell chooses to immediately replace the grommet, but often it is decided to wait to see if symptoms return.

 

Will my child require more than one set of grommets?

2 out of 10 children may require a second operation. Only a very small proportion of patients carry the problem to adulthood.

 

Does the surgery damage the ear drum?

Frequent operations on the ear drum may cause it to be weaker but the presence of fluid or infection in the middle ear will affect hearing and may lead to significant long term problems.

 

DISCHARGE INSTRUCTIONS

 

Your child has grommets (small plastic tubes) in the ear drums. They will normally stay in place for a period varying from nine to twelve months. Mr Russell will tell you when they have fallen out, and the ear-drums have healed, at your follow-up appointments.

 

Until then, please follow these instructions:-

 

1. If the ears begin to discharge, please contact Mr Russell.

 

2. If water in the ears is uncomfortable, plugs can be used. Blu-tac is commonly useful. Doc's "Pro-plugs" (the ones without holes) can be bought from hearing-aid suppliers, surf shops and chemists along the coast. Some people prefer specially moulded plugs. (Available from hearing aid specialists). These are more expensive, but are the most effective.

 

3. Do not go swimming during the first week after the operation. After this it is safe to swim.

 

4. You may travel in an aeroplane.

 

5. Your child has had a general anaesthetic and it may take one or two days to fully recover, so allow only gentle exercise.