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The function of a grommet is to ventilate the middle ear, rather than drain
it. Grommets thus replace the function of the blocked eustachian tube in glue
ear and improve hearing.
Post-operatively the ear should be kept dry and
any further discharge mopped up and treated with antibiotic/steroid drops. If
discharge continues another referral may be required.
There is controversy
about swimming and other activities in the period before the grommet falls out
- research seems to suggest that bathwater is the worst culprit.
will extrude after a variable period - 6 to 18 months. Repeated insertion may
be necessary as 1 in 5 children requiring surgical treatment.
A horse shoe
shaped thickening and calcification of the drum may follow grommet insertion,
though this rarely causes hearing loss.
NICE suggest that the persistence
of bilateral otitis media with effusion (OME) and hearing loss should be confirmed
over a period of 3 months before intervention is considered. The child's hearing
should be re-tested at the end of this time:
- during the active observation
period, advice on educational and behavioural strategies to minimise the effects
of the hearing loss should be offered
- children who will benefit from
- 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
- 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
- once a decision has been taken to offer surgical intervention
for OME in children, the insertion of ventilation tubes is recommended. Adjuvant
adenoidectomy is not recommended in the absence of persistent and/or frequent
upper respiratory tract symptoms
- children who have undergone insertion
of ventilation tubes for OME should be followed up and their hearing should be
- study evidence however suggests
that the role of grommets in the management of glue ear is unclear.
systematic review concerning the use of grommets in glue ear (otitis media with
effusion) concluded that the benefits of grommets in children appear small (2)
- the effect of grommets on hearing diminished during the first year
adverse effects on the tympanic membrane are common after grommet insertion
treated with grommets had an additional risk for tympanosclerosis of 0.33 (95%
CI 0.21 to 0.45) one to five years later
- the authors recommended
that an initial period of watchful waiting seems to be an appropriate management
strategy for most children with otitis media with effusion
study showed that, in infants and toddlers with persistent middle ear infusion,
prompt insertion of tympanostomy tubes was not more effective than delayed insertion
for developmental outcomes at 9-11 years (3)
- this study provides further
evidence to show that a conservative wait-and-see approach will give the best
outcome in children <= 3 years of age, avoiding unnecessary operations
(February 2008). Surgical management of otitis media with effusion in children
J et al. Grommets (ventilation tubes) for hearing loss associated with otitis
media with effusion in children. Cochrane Database Syst Rev 2005; (1): CD001801
JL et al.Tympanostomy tubes and developmental outcomes at 9 to 11 years of age.
N Engl J Med. 2007 Jan 18;356(3):248-61.
Last reviewed 01/2018