What are grommets?

Posted on 3 December 2020

Children who suffer from repeated middle ear infections may benefit from having tiny plastic tubes called grommets inserted into their eardrum during a short, simple procedure.

Kathryn Rossiter, a Cape Town mother of two, says her daughter’s grommet procedure was life-changing – not just for the little girl but for her parents too. “We were worried about our 18-month-old daughter’s recurring ear infections and the long-term implications – we were concerned they might affect her hearing and speech development,” Kathryn explains. After many visits to the GP, they were eventually referred to an ENT specialist, who suggested grommets.

The middle ear is an air-filled space that contains three tiny bones – the malleus, incus and stapes – which amplify sounds and pass the vibration on to the inner ear. The middle ear is connected to the back of the nose and the throat by the Eustachian tube that allows air to enter the middle ear. This area helps to maintain an equal air pressure inside and outside of the middle ear. Fluid and mucous from the middle ear drains to the back of the nose and throat.

Dr Hennie Liebenberg, a paediatrician at Mediclinic Louis Leipoldt, says children are more susceptible to middle ear problems because of their relatively immature immune system. “Their immune system is still forming, which makes them more susceptible to viral and bacterial upper respiratory tract infections (URTIs),” he explains. “They’re also at risk of repeated URTIs because of close contact with other children in a creche or school setting and the fact that the Eustachian tube has not fully developed or formed yet.”

Dr Liebenberg adds that middle ear problems usually develop in the first year-and-a-half of a child’s life – a crucial time for their speech and language development. “A developing brain can’t develop speech without normal hearing, and middle ear problems can cause some sort of hearing impairment,” he says. “That’s the main reason why paediatricians timeously refer recurrent middle ear problems to an ENT specialist.”

Dr Michael Molyneaux is an ENT specialist at Mediclinic Constantiaberg. “If the Eustachian tube is not working properly, or is blocked due to inflammation or mucous, the air in the middle will be absorbed but not replaced, causing the air pressure in the middle ear to be less than the air pressure in the ear canal,” he explains. “This imbalance causes fluid to collect inside the middle ear. The purpose of a grommet is to do the work the Eustachian should be doing; it allows the middle ear to recover.”

Grommets are tiny tubes that are inserted into the eardrum to treat conditions affecting the middle ear, Dr Molyneaux adds. These can include ear infections or “glue ear” (otherwise known as otitis media with effusion), which is a persistent build-up of fluid in the middle ear that can cause hearing problems. Grommets are a temporary measure and will buy time until your child’s Eustachian tubes mature to work naturally, Dr Molyneaux says. “They cause no discomfort while in place and usually fall out on their own in six to 12 months, leaving the drum intact.”

Inserting a grommet involves a simple surgical procedure called myringotomy, where a small cut is made in the eardrum and any fluid is suctioned out. The grommets, also known as ventilation tubes, or tympanostomy tubes, are then inserted into the eardrums to drain fluid and ventilate the middle ear. The procedure usually takes about 15 minutes.

As Kathryn says, her family has never looked back. “After the procedure, my daughter was able to continue her swimming lessons, plus her hearing, speech and general behaviour improved. She also had less infections, which meant we didn’t spend as much money on doctors’ appointments and antibiotics. She could attend playschool more regularly, which meant fewer disruptions to our work schedules. And best of all, we were all able to sleep better – which is invaluable to all parents!”

Mediclinic’s Fixed Fee Packages are available for a broad range of common procedures to assist private patients (those without medical aid or who have exhausted their medical aid). Mediclinic has a set number of procedures, including grommet insertion, on the list which will be continually updated.