Hearing health

Ear grommets for ear infections and glue ear treatment

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Author: EarPros Team

Ear grommets are small ear tubes inserted into the eardrums by healthcare professionals, addressing conditions known as otitis media and 'glue ear,' where a dense, sticky fluid accumulates in the middle ear, often following repeated ear infections. The insertion of grommets is generally pain-free. These devices also referred to as tympanostomy tubes or ventilation tubes, play a crucial role in managing middle ear conditions and improving auditory function.

What are ear grommets and how they works

Grommets are small devices designed to equalise pressure in the middle ear by permitting air to enter from outside. This helps prevent the accumulation of fluid, reducing potential complications and symptoms of glue ear and effusive otitis. Constructed from either plastic or metal, grommets facilitate the entry of air into the middle ear and aid in the drainage of the thick fluid through the nasal and throat passages.

They serve as a temporary solution, aiding in ear function until the Eustachian tubes, which link the middle ear to the nasal passage, develop fully and can perform their role effectively. The tubes are inserted in the ear canal through a surgical procedure called myringotomy.

Typically, grommets remain in place for between six to eighteen months before they naturally fall out as part of the ear's normal processes. The ear grommet is usually less than 2 mm tall and smaller than a match head. It can also be called a T-tube, ear tube, pressure equalization tube, vent, PE tube or myringotomy tube.

Middle ear anatomy to show where ear grommets should be placed

Fluid in ear and glue ear treatment with grommets

Glue ear, medically known as 'otitis media with effusion', involves the accumulation of ear fluid behind the eardrum in the middle ear, which thickens over time. This condition predominantly affects young children, often following a cold or ear infection. The buildup of fluid in the ear can lead to hearing difficulties, potentially impacting speech and language development due to reduced auditory input. While the ear fluid may naturally resolve within three months, persistent cases require intervention. Glue ear treatment includes the insertion of grommets, small tubes that facilitate the drainage of fluid, thereby alleviating the condition.

What causes glue ear in adults and kids

Glue ear arises when the Eustachian tube, which links the middle ear to the back of the nose, becomes blocked. This tube is essential for maintaining air pressure and draining fluid from the middle ear, crucial for clear hearing. Blockages, often due to swelling from a cold, prevent fluid from escaping, leading to accumulation and potential infection in the middle ear.

Children under the age of 7 are particularly susceptible to glue ear, as their Eustachian tubes are smaller and less inclined. Factors increasing the risk include having hay fever, a cleft palate, Down syndrome, exposure to cigarette smoke, frequent childcare attendance with many other kids, or prolonged use of a dummy.

While less common in teenagers and grown-ups, glue ear in adults warrants thorough examination to exclude the possibility of a tumour in the nasal or throat areas as the underlying cause.

How to treat glue ear in adults

Glue ear in adults is usually treated with antibiotics or nasal sprays, while ear tubes are not used very often. While glue ear in childhood is a widespread issue, this type of infection is less frequent growing up. For adults and children with ear discharge, antibiotic ear drops and rinsing the ear with saline may be more effective than oral antibiotics.

Ear grommets in adults: recovery time and insertion

Woman smiling, with some friends in the background at her table

For adults experiencing ongoing effusive otitis and hearing issues that impact daily activities, considering grommet surgery might be beneficial, especially if other treatments like antibiotics or nasal sprays haven't yielded results. This procedure involves ear tube placement, which can be a permanent solution for chronic conditions.

Before the procedure, a comprehensive evaluation with an ENT specialist is essential. This will include a review of the patient medical history, an in-depth examination of the ears, nose, and throat, and a hearing test. Additional diagnostic tests, such as an MRI scan, might also be required to ascertain the necessity and suitability of the procedure.

The recovery period following ear grommet insertion for adults is relatively swift, with most individuals experiencing minimal discomfort. Generally, patients can resume activities like swimming after two weeks, avoiding jumping, diving, or underwater swimming until a follow-up appointment, typically scheduled six weeks post-surgery. Most adults can expect to return to work or their routine activities within 2 to 3 days after the operation, although taking 1 to 2 days off for complete recovery might be advisable.

Treating ear infection with grommets in kids

For children experiencing persistent glue ear or recurrent ear infections, doctors might suggest the insertion of grommets. This recommendation usually comes into play under specific circumstances, such as:

If the child has been suffering from glue ear for over three months, particularly when it's associated with significant hearing loss.
Experiencing six or more acute ear infections within a year, especially if these infections are affecting both ears.
Recurring infections during the summer, a period typically associated with a lower incidence of such conditions.
Any previous ear infection complications.

Ear tubes can provide relief and prevent further issues, particularly in cases where conventional treatments haven't been effective. They are particularly useful for managing glue ear, a condition that can significantly affect a toddler's behaviour and overall development, including their ability to hear and learn. Glue ear in kids can lead to noticeable changes in behaviour due to the frustration and communication difficulties arising from hearing loss.

What if I can see the grommet in my child's ear

Seeing the grommet in your child's ear might be normal, especially if it has not fallen out yet. If the grommets have discharged from the eardrums then occasionally you may see a grommet in the outer part of the ear canal. However, if there are signs of infection, like yellow fluid coming out of your child's ear, or other concerns, it's essential to consult a healthcare professional. The average time for a grommet to become visible is approximately 12 months. It is usually a small black tube and if seen in the outer ear could be gently plucked away with a pair of tweezers.

An old man with a younger generation smiling at each other while exercising outside

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Ear tubes for chronic otitis media and barotrauma

The procedure is considered for other specific conditions, such as:

Frequent acute otitis media, defined as three episodes within six months or four within a year, although the supporting evidence for this criterion is not strong.
Chronic otitis media with effusion lasting over six months in one ear or three months in both ears.
Ongoing dysfunction of the Eustachian tube.
Barotrauma prevention, particularly to avoid repeated occurrences, which might follow activities like flying or undergoing hyperbaric oxygen therapy.

It is advised against using grommets for children experiencing a single episode of otitis media with effusion (OME) if it resolves within three months.

Grommet surgery: the myringotomy procedure

Grommet surgery, also known as myringotomy, is a relatively quick procedure in the United Kingdom. It typically lasts about 20 minutes, although it can be as brief as 10 minutes in some cases. This surgery is generally carried out under general anaesthesia, but local anaesthesia may be used in certain situations.

The ear tubes, placed in the eardrum, help to equalise air pressure by allowing air to flow through. During the myringotomy procedure, a surgeon creates a small incision in the eardrum to insert the grommet. Typically, the tympanostomy tube remains in position for six to twelve months before naturally falling out. This process for grommet ear insertion is standard and poses no harm to your child.

Private grommet surgery cost in United Kingdom

In the UK, the cost of private grommet surgery varies by hospital and location. Generally, private ENT surgery costs in the UK range from approximately £2,000 to £6,500, depending on the specific procedure required. This cost can include grommet insertion surgeries. These figures are indicative and can fluctuate based on the hospital choice, the surgeon's fees, individual patient requirements, the healthcare provider and geographic location. For accurate ear tube placement pricing, it is advised to consult a healthcare professional or your local healthcare service. The myringotomy cost can also vary depending on whether it is for an adult or a child and the chosen hospital. A formal quotation is typically provided after consultation with an ENT specialist and any required tests.

Grommet operation: risks and complications

Although being an averagely safe procedure, after the grommet operations a few complications may arise. Here are the most common risks:

Blocked grommet

In the grommet procedure, a common aftercare consideration is the potential for the tympanostomy tube to become blocked. If this occurs, ear drops may be prescribed to resolve the blockage. A minority of children might experience continuous fluid discharge from their ears post-procedure.

Perforated eardrum

A notable, albeit small, risk associated with grommet removal is the possibility of a persistent hole in the eardrum. Should this arise, surgical intervention may be required to mend the eardrum, typically recommended for children over the age of 8.

Surgery for grommet removal

Furthermore, in some instances, T-tubes do not self-expel within three years. In such cases, a minor procedure under general anaesthesia might be necessary to extract the grommets. The decision to remove functioning grommets should be carefully balanced against the potential recurrence of ear infections and glue ear. It's advisable to discuss these concerns with a family physician or an ENT specialist to make an informed decision tailored to the child's specific needs.

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Before and after the grommet procedure

Following a grommet operation, hearing typically improves swiftly. It's common to notice a bit of discharge or bleeding from the ear for a day or two post-surgery, which is considered normal. Some mild discomfort may occur after the procedure, but it can be alleviated with over-the-counter pain relievers like paracetamol, adhering to the dosage instructions provided. A subsequent hearing test will determine the improvement in hearing. Should hearing not fully recover, additional evaluations might be necessary.

To care for your child's drainage grommet, it's crucial to prevent ear infections by avoiding the entry of unclean water into the ears. ‘Dirty water’ includes bath water, heated pools, spas, rivers, lakes, dams and creeks. It's essential to keep ears dry when bathing and washing hair.

How long to keep ears dry after grommets?

Maintaining dryness in the ears until the grommets naturally dislodge and the eardrums heal is advisable. Consult your healthcare provider for guidance on safeguarding your child's ears from water exposure while the grommets are in place. Showering, even with hair shampooing is fine. Ear tubes can also be protected using children's earplugs or as alternatives:

Cotton wool smeared with Vaseline
Custom ear plugs can be made by hearing aid suppliers
Soft plastic plugs can be bought at some shops
Silicone ear putty

Can you swim with grommets?

Yes, swimming with grommets is possible, but it's important to adhere to certain guidelines to ensure safety. Initially, a two-week healing period post-grommet insertion is crucial, during which swimming should be avoided to minimize infection risks.

After this healing phase, swimming can resume with precautions such as wearing swimming earplugs or a swim cap to keep water from entering the ears. Bathing is not restricted for individuals with tympanostomy tubes, allowing for regular practices without concern. It is also allowed to swim underwater.

For those swimming in public pools, additional measures like silicone swim caps, headbands and goggles are recommended to further protect the ears. Swimming in ocean waters and showering in clean water do not require special precautions. In natural bodies of water, you shouldn't dive too deeply to avoid increased pressure that might force water through the grommet, potentially leading to infection.

Consultation with a healthcare provider is advisable for personalised advice.

Are ear grommets falling out naturally?

Ear grommets are designed to fall out naturally within 6 to 12 months as part of the normal healing process. The duration before they fall out can vary based on factors such as the grommet's size, shape, material, and the individual characteristics of the ear. Once a grommet falls out, the eardrum's puncture usually heals rapidly. However, some children may experience a recurrent fluid buildup and might require further treatment.

It's common and expected for grommets to fall out on their own, and this event should not cause alarm. Following the expulsion of a grommet, a follow-up hearing test is advisable to evaluate the child's auditory status. While ear discharge may occur post-insertion, it typically does not result in pain and can be managed with ear drops. Should there be any concerns or unusual symptoms post-fallout, seeking advice from a healthcare provider is recommended for proper guidance.

What happens if grommets don't fall out?

In rare instances, grommets may not naturally be expelled within three years in some children. Under such circumstances, a minor procedure under general anaesthesia might be necessary to remove the ear tubes. It's crucial to balance the decision for grommet removal with the risk of recurring ear infections and glue ear. Should grommets remain beyond their intended period, several issues might arise:

Ear infections: The extended presence of grommets can increase the likelihood of infections in the ear canal due to continuous exposure to external elements.
Hearing concerns: Grommets are placed to improve hearing issues linked with conditions such as glue ear. Failure to fall out as expected could hinder hearing progress, necessitating further medical intervention.
Eardrum challenges: Overstaying grommets might lead to rare but severe complications like eardrum hardening and calcification, impacting hearing and ear health.

It's essential to consult your healthcare provider if grommets don't expel naturally within the anticipated timeframe to manage any potential complications or concerns arising from their prolonged stay in the ear.

Can a grommet get stuck in ear canal?

Yes, ear grommets can occasionally get stuck in the ear canal or the middle ear, though this is rare. When a grommet does not fall out on its own, medical removal might be necessary. To prevent this, it's important to follow post-operative care closely and attend regular check-ups to monitor the grommet's position. Avoid inserting objects into the ear that could push the T-tube deeper. If an ear infection has been treated, ensure the ear is checked for any tear tube displacement or blockage. If your ear feels blocked after grommet surgery, it's important to see a professional. Typically, grommets exit the ear naturally within 6 to 18 months as the eardrum heals. However, if a grommet remains, a second surgery may be required for removal.

Blocked grommets symptoms

Doctor demonstrating a plastic ear to a patient

Blocked grommets can lead to several symptoms affecting the ears, which are important to recognise for timely management:

Hearing Reduction: A noticeable decrease in hearing capabilities is a common indicator of grommet blockage, as it hinders sound from moving efficiently through the ear.
Glue Ear Discharge: The accumulation of fluid, often yellow or green, might occur in the ear canal due to blockage, and this discharge could have an unpleasant odour.
Risk of Ear Infections: The presence of blocked grommets can elevate the likelihood of infections in the ear, manifesting as pain, swelling, and general discomfort. The feeling of a blocked ear after grommet insertion cannot be ignored.
Dizziness and Balance Difficulties: Some individuals might experience issues with balance or dizziness, a result of the ear's impaired functionality due to blocked grommets.
Ear Pain and Discomfort: A sensation of fullness, discomfort or pressure in the ear, which can occasionally lead to pain, is another symptom that might be experienced.
Formation of Ear Polyps: In cases of prolonged blockage, ear polyps, or abnormal tissue growths in the ear canal, could develop.

It's crucial to seek medical advice if these symptoms are present, as blocked ear tubes may require professional intervention or possibly the replacement of the grommets to alleviate the issue.

Ear grommets side effects: ear wax and infections

While beneficial, it's important to consider potential grommets side effects:

Hardening of the eardrum

Rarely, the eardrum may harden or calcify post-tube insertion, potentially affecting hearing and necessitating further intervention.

Hearing loss

Hearing loss is an uncommon but possible risk associated with tympanostomy tube placement, warranting a discussion with your healthcare provider beforehand.

Tinnitus

A few individuals might experience tinnitus, characterised by ringing or buzzing in the ears, after grommet placement, though this is rare.

Dizziness

It is another infrequent side effect post-grommet insertion. Should this occur, seeking medical advice is recommended.

Ear discharge or infections

Ear infections or discharge are the most frequent complications, yet they are usually manageable with proper care.

Minor side effects

Post-procedure, some children might face temporary issues like nausea or a sore throat, typically resolving within a few days and manageable with medication if needed.

Excessive ear wax after grommets

It can also occur. It's essential to have a detailed discussion with your healthcare provider about the potential risks and benefits of inserting an ear drum grommet, especially for children, to make an informed decision based on individual health needs.

Alternatives to ear tubes for adults and kids

Doctor fitting a hearing device for a female patient

For both adults and children, there are several alternatives to traditional ear tube surgery. Always consult with a healthcare professional to determine the most appropriate alternative based on the specific ear condition and individual needs. Here are the procedures:

Eustachian Tube Balloon Dilation: This technique involves using a catheter to widen the Eustachian tube through inflation, enhancing ventilation and fluid drainage. It's particularly beneficial for persistent Eustachian tube issues in adults and offers a non-surgical option.
Hummingbird Ear Tubes: Representing an innovative approach, this method allows for the placement of ear tubes without the need for general anaesthesia, presenting a less invasive solution for all ages.
In-Office Ear Tube Placement: Some healthcare providers can insert ear tubes during a simple clinic visit, streamlining the process and making it less daunting, especially for children.
Natural Remedies: In milder cases, options like dietary adjustments, chiropractic treatments, and homoeopathic strategies might alleviate ear problems, potentially bypassing the need for ear tubes in younger patients.

FAQs about ear grommets

Can you shower with grommets?

Yes, showering with grommets is possible. It is generally safe to shower with grommets. Water from a regular shower should not cause any harm to the grommet or your ear. However, it's essential to avoid forcing water into your ear canal by using high-pressure showers or directing the stream of water directly into your ear. Be gentle while washing your ears and ensure that no soap or shampoo enters your ear canal, as this can lead to irritation or infection.

What age can grommets be fitted?

Ear grommet placement is most commonly needed in children between the ages of one to three years old.

What happens if you get ears wet after grommets?

Once water reaches the middle ear it presents a risk for infection. As tympanostomy tubes are not a natural part of the body, they can sometimes develop a film of bacteria known as a “biofilm” which resides on the grommet. This may lead to recurrent discharge from the ear.

How many ear infections before grommets?

T-tubes are recommended if the child has had glue ear for more than 3 months, depending on the degree of hearing loss, or 6 acute ear infections in one year, especially if the infections have occurred in both ears.

Can you fly with grommets in your ears?

Yes, you can fly with grommets in your ears and it is generally safe. The pain from the change in pressure in the aeroplane should not happen when the grommets are working. Grommets allow air to pass in and out of the middle ear, which helps equalize pressure during changes in altitude while flying. This prevents discomfort and potential damage to the eardrum caused by significant pressure differences inside and outside the ear. Therefore, flying after grommet insertion is often more comfortable than before, as the ear pressures automatically equalise through the grommet.

Can you still get ear infections with grommets?

Yes, you can still get ear infections with grommets. Colds, flu, and ear infections can still lead to discharge from the ears even in children with grommets. T-tubes primarily help with drainage and ventilation, but they do not make the ears completely immune to infections.

Can grommets cause perforated eardrum?

While they generally don't lead to a perforated eardrum, this can be considered a possible complication. Grommets can sometimes cause scarring or irritation of the eardrum.

Can a grommet get stuck in middle ear?

Yes, a grommet can get stuck in the middle ear. In some rare cases, grommets can become blocked or fall out too soon, leading to them being stuck in the middle ear.

Can you use ear drops with grommets?

You can use ear drops with grommets, but it's important to follow the guidance of a healthcare professional for proper care. When children with grommets experience ear infections or ear discharge, topical antibiotic ear drops may be recommended as part of the treatment plan. In some cases, ear drops may also be used to clear blockages that can occur in the grommets.

Are tympanostomy tubes permanent?

No, ear tubes are temporary and usually fall out on their own over time in a process called extrusion The duration can vary, but ear tubes typically remain in place for around 6 to 12 months. They may last longer or shorter depending on the individual's condition and the type of tube used.

How long do tubes stay in ears?

Tympanostomy tubes are temporary and often fall out after 12–14 months as the ear heals. When it is necessary to keep the middle ear ventilated for a very long period, a T-shaped tube may be used, as it can stay in place for 2–4 years.

Can ear tubes get clogged?

Yes, grommets can get clogged. Grommets can become clogged due to various reasons, including the accumulation of earwax, debris, or even blood clotting around the tube.

Can ear tubes help tinnitus?

Yes, they can help but ear tubes themselves are not primarily used to treat tinnitus. They are more focused on improving ventilation and drainage in the middle ear, which can help manage conditions that may indirectly contribute to tinnitus, such as chronic ear infections or Eustachian tube dysfunction.

Can ear tubes cause vertigo?

Yes, they can. While ear tubes themselves do not directly cause vertigo, complications related to Eustachian tube dysfunction and imbalances in the inner ear's vestibular system can lead to vertigo-like symptoms in some cases. If you experience vertigo after ear tube placement, it's important to consult with a healthcare professional for a proper evaluation and appropriate management.

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