Your guide to glue ear and grommet insertion in children

Grommet insertion is a surgical procedure used to treat persistent glue ear. Here, we will explore what glue ear is, its symptoms and how it is diagnosed. Then, we will discuss key aspects of grommet insertion, from when it is appropriate to what to expect and the risks associated with it.

Glue ear explained

Glue ear is also known as otitis media with effusion (OME). If refers to a build-up of fluid in the middle ear. This is one of three parts of the ear, which includes the outer ear (where wax builds up) and the inner ear. The middle ear sits behind the eardrum and is normally an air-filled space that contains three tiny bones, which are essential for hearing.

Causes and symptoms of glue ear

It may be caused by an infection, such as the common cold, although a range of factors may make a child more likely to develop glue ear. This includes inflammation of the adenoids at the back of the nose. In young children, the tube that connects the middle ear to the back of the throat (the Eustachian tube) may not work properly. This tube balances the pressure in the middle ear with the pressure in the environment and helps drain fluid that collects in the middle ear. 

When the Eustachian tube is blocked, fluid (“glue”) builds up in the middle ear and prevents the eardrum from vibrating in response to sounds. This causes symptoms including: 

• Hearing loss — very young children may find it difficult to express that they have hearing loss
• Changes in behaviour, specifically becoming shy and withdrawn
• Needing to turn up the volume eg when watching TV
• Poor balance and clumsiness
• Speech and language delay — this may occur if glue ear is prolonged

Glue ear diagnosis and treatment

If you notice these symptoms in your child, take them to see your GP. They may be able to diagnose glue ear based on your child’s symptoms and by looking into your child’s ear with a handheld device with a light on the end, called an otoscope. 

However, in some cases, they may need to refer your child for hearing tests, including: 

• An audiogram to check their level of hearing
• A tympanogram to check the pressure in the middle ear and whether the eardrum is moving or not

In most cases, glue ear will get better on its own within three months without any treatment. Your child will, however, be monitored with two hearing tests at least three months apart, and they may occasionally also be provided with hearing aids. 

In children aged three years or older, autoinflation — that is, techniques to help drain the middle ear by inflating a balloon through a nostril — may be recommended to speed up their recovery. 

However, in persistent cases of glue ear where there is concern that it may be affecting your child’s learning and development, grommet insertion surgery may be recommended. This may be performed alongside a procedure called an adenoidectomy, which removes the lymphatic tissue that sits at the back of the throat behind the nose (the adenoids). 

What is grommet insertion surgery?

Grommet insertion surgery is a day case operation, which means your child can go home on the same day as their surgery. It will be performed under a general anaesthetic and takes 10–15 minutes. 

Your surgeon will use a special microscope to look into your child’s ear. They will clean the eardrum and make a small hole in it, through which they will suck out the fluid sitting inside the middle ear. 

Next, a tiny tube called a grommet will be placed into the hole created in the eardrum. The grommet has a wide rim on each side of the tube called a flange, which will help hold the grommet in place. This allows the air pressure to balance across the eardrum and will prevent any fluid from building up in the middle ear. Grommets are usually made of plastic but occasionally metal ones are used.

There are three types of grommet, which each remain in place for varying amounts of time before they naturally fall out as the eardrum heals. They are the: 

• Mini-grommet — this is smaller than a standard grommet and tends to stay in place for a few months
• Standard grommet — this stays in place for around 6–12 months
• Long-term grommet — this is bigger than a standard grommet, is used in older children and adults, and can stay in place for several years

Grommet insertion surgery can be performed in children as young as two years at some Spire hospitals.

Preparing for grommet insertion surgery

At Spire Healthcare, you will be invited to bring your child along to the hospital before the day of their surgery. They will have the chance to see the room they will be in, meet our nurses and visit the play area. This will help your child feel as comfortable as possible on the day of their surgery. 

Aside from mentally preparing your child to go into hospital, and sticking to the rules regarding eating and drinking before surgery, there is no other preparation needed before grommet insertion surgery. 

Risks of grommet insertion surgery

Grommet insertion surgery is generally a very safe procedure that carries few risks. 

However, there is a small risk of an ear infection. This can usually be effectively treated with antibiotic ear drops. Occasionally, an ear infection can cause the grommet to fall out earlier than expected. 

In most cases, when the grommet falls out, the hole created in the eardrum heals over quickly. 

There is also a small risk of the grommet becoming blocked by mucus. This blockage can often be resolved by using ear drops.  

In a very small minority of cases, persistent ear infections and discharge from the ear can occur after grommet insertion surgery. This is usually due to another underlying health issue. 

Recovering from grommet surgery

In most cases, your child will only need to rest at home for a day, so the effects of the general anaesthetic can wear off. They can then return to their usual activities, including school. 

However, they will need to be careful around water for one month after their surgery. When having a bath or shower, an earplug or cotton wool with petroleum jelly should be placed into their ear in the short term. 

They should also avoid swimming for one month. In the long term, most surgeons recommend using an ear plug when swimming while the grommet is in place.

It is usually safe for them to fly with a grommet in place. 

When is an adenoidectomy needed?

The adenoids are small pyramid-shaped mounds that sit at the back of a child’s throat behind the nose. They start to shrink after age four and completely disappear by adulthood. 

The adenoids are a type of lymphatic tissue and help the body recognise and respond to any bacteria and viruses that are breathed in. When bacteria or viruses enter the adenoids, they can respond by swelling as they deal with the infection. In some cases, the adenoids themselves can become infected (adenoiditis), which also causes them to swell.

Inflammation of the adenoids may be one cause of glue ear. 

Consequently, if your child has enlarged adenoids, your doctor may recommend that their adenoids are removed at the same time as they have their grommet insertion surgery. Removal of your child’s adenoids will not negatively affect their immune system and can help prevent glue ear in the long term.

Adenoidectomy procedure

It is performed under a general anaesthetic and takes around 20 minutes. Your child’s mouth will be opened to access their adenoids. Adenoids can be removed by a range of different techniques including curettage (scraping them out),  suction diathermy, where heat from an electric current and suction are used, or via coblation, where radiofrequency energy is used. 

Adenoidectomy is a low-risk surgery but as with most surgeries, there is a risk of excessive bleeding. This occurs in around one in every 1,000 adenoidectomies. 

Outcomes for grommet surgery

Grommet insertion surgery has a very high success rate and provides relief from glue ear symptoms for, on average, a year. Only around one in four children who have grommet insertion surgery need to have the surgery repeated because glue ear symptoms return. 

If grommet insertion surgery is performed alongside an adenoidectomy, even longer-term relief from glue ear symptoms is provided. Only around three in 20 children who have grommet insertion surgery and adenoidectomy need to have the surgery repeated because glue ear symptoms return.