What is a grommet and why is it inserted in an ear in the operation called myringotomy with grommet insertion?
A grommet is a miniature plastic tube that is placed inside an especially created hole in the eardrum so as to let the air get in and out and improve ventilation of the middle ear. Myringotomy with grommet insertion is conducted in patients suffering from a condition called glue ear i.e. fluid accumulation in ear, or those with a retracted eardrum. Such conditions afflict children more than they do the adults and have an adverse effect on hearing and speech faculties of the patient. Grommets can remain inside the ear for 6 months to a year (sometimes longer). As the eardrum grows, grommets fall out by themselves and this extrusion is rarely noticed.
In children, this surgery is mostly performed under a short-duration general anaesthesia. The surgeon creates a small nick in the eardrum and a grommet is slipped through and secured. As more often than not, the underlying condition affects both ears, the same procedure is repeated in the other ear as well. As the eardrum grows, the grommets falls out on their own and need to be taken out surgically only in rarest of rare cases. At times, extrusion of a grommet leaves behind a tiny hole that mostly heals up on its own without needing any surgical closure (in some cases, it may require a further surgery). While the grommet can cause some scarring in the eardrum, it has no adverse effect on the hearing ability.
Not every case of glue ear requires a myringotomy with grommet insertion as quite a few such cases take some time but self-heal by themselves. When it comes to children, at Dr. Rao’s ENT Super Speciality International Hospital, we first wait and watch for the first three months to give the ear a chance to heal itself. After which, the child is given another evaluation. If the condition is still there but in a near-harmless state, it is again given some time to get better. On the other hand, if the glue ear is causing hearing, speech or infectious problems, the surgeon may decide to perform a myringotomy with grommet insertion. However, in one child out of every three, when the grommet falls out, the glue ear condition arises again. If so, the surgeon might have to perform successive myringotomies with grommet insertions until the glue ear stops making a comeback.
Yes, your child will be able to take up swimming two weeks after the surgery and that too without using earplugs. While the hole in the grommet is too small to let any water go through, dirty or soapy water in the ear has to be avoided totally. So diving under the water is out of bounds completely. Even at the time of bathing or showering, you will have to cover their ear holes with Vaseline petroleum jelly covered cotton balls. .
My child will be undergoing a myringotomy grommet surgery soon. What are the pre-operative instructions to be followed prior to it?
The pre-operative checklist is as follows:
- Make sure that your child stops taking any food six hours prior to the surgery.
- Till the preceding night of the surgery, ensure that your child takes all the medications prescribed by the ENT surgeon.
- Bring along any prescription or non-prescription medicines your child is taking (in original packaging/bottles) when you check in for surgery the next morning. If your child is using an inhaler or a breathing device, bring along that too.
- Bring along special formula/breast milk for post-operative feeding of your infant.
- Your child can bring along a favourite comfort item - blanket, stuffed animal, or pacifier etc. – which will be allowed inside the Operating Room and the Post Operative Recovery Room. Children can also bring along movies, books or games if they will be staying at the hospital overnight or through the day.
- Please be prepared to dedicate the entire day to your child’s surgery and recovery. We request you to make due arrangements for your other children at home well in advance. It is essential that we as surgeons, and you as parents, can together devote complete attention to the child undergoing surgery.
- Please ensure that you report at the hospital at least three hours prior to the surgery’s scheduled timing.
- Report at the reception desk in time and the hospital staff will guide you through the next steps.
- If you have felt any changes in your child’s physical condition such as cough, cold, fever or throat pain, be sure to mention it to your doctor and anaesthetist. If your child is allergic to any drugs, be very sure to mention that as well.
Please read the following information carefully to get further clarity on the pre-operative instructions including special instructions for patients with diabetes, respiratory or cardiac problems.
What are the post-operative instructions I/ my child need to follow after myringotomy with grommet insertion?
First 24 hours:
- Your child should take complete bed rest on the day of the surgery.
- The child will not be allowed any drink or food till 4-5 hours after the surgery. After the surgical staff gives the go-ahead, you can give them water to sip. A while later you can also give them milk or Horlicks etc. However, caffeinated beverages such as tea, coffee or aerated drinks are to be avoided as these can cause gastric irritation when consumed on an empty stomach. You can start them on a semi-solid diet in moderate quantities after 12 hours. Normal food is allowed from second day onwards.
- While grommets usually do not hurt at all, you can still give your child a painkiller if required.
- As up till the surgery, the child has been living with lowered hearing, post-surgery they may find every sound as ‘too loud’. It may take them a few days to get acclimatized to normal hearing.
- In most cases, the child can return to school/ playschool the day after the surgery.
- Do not let any water get into the operated ears for at least two weeks after the day of surgery.
- Please ensure that all the medications prescribed to your child are duly taken.
What will be the schedule of my child’s post-operative follow up visits after getting myringotomy with grommet insertion?
After your child is discharged from the hospital, you will have to bring them for a routine check up after 7 days. Any follow up visits will be as advised by the operating surgeon.
Like any surgery, a myringotomy with grommet insertion too comes with plenty of benefits as well as some degree of risk. The risks of this procedure are as follows:
- Infection: Grommets or tubes are placed in the ear to restore normal ventilation and air pressure equalisation in the ear canal. Patients with infected ears will have drainage of infection through the grommets that can stretch over many days. Some cases may require further antibiotic treatment (sometimes direct administration into the ear through the grommet) till all the infection is cleared up. The child may still be prone to ear infections in future, especially during a cold, but the frequency should go down and the treatment should also be easier.
- Early extrusion: The grommets inserted in the ear are likely to remain in place for 6 months to 1 year which, in most cases, is sufficient time for the ear to outgrow its infection catching tendency. However, sometimes the grommets are pushed out by the eardrum sooner than intended. This can increase the chances of a repeat procedure for insertion of fresh grommets.
- Permanent perforation: As we have explained earlier, the grommet is pushed through a tiny hole created in the eardrum by the surgeon. While this hole heals itself after the grommet is pushed out, in 1 or 2 patients in every 100, the hole may not self-heal and may need a repairing surgery which is a very safe and sure procedure. However if the grommet is designed for long-term insertion (designed to stay in for many years), the risk of a permanent hole in the eardrum becomes higher.
- Hearing: Grommet insertion is an extremely safe surgery. It not only does not affect normal hearing, it also rectifies any hearing loss caused by fluid accumulation or infection behind the eardrum. In small children undergoing this procedure, pre-surgery hearing is not fully measured hence, accurate hearing assessment can only be given after they grow up some more.