With each episode of ear infection fluid accumulates in the middle ear. In 90% of children this fluid will clear in two to three months. If the fluid persists it is known as “glue ear”, the name reflecting the thick sticky nature of the fluid. This condition occurs if the eustachian tube (connecting the nose to the ear) does not function properly, such as in small children. The eustachian tube is designed to drain and aerate the middle ear via the nose. The peak incidence of glue ear is between three and six years old though it can occur as early as in the first year of life.
The presence of fluid can cause problems such as a 10-40 decibel loss of hearing leading to poor speech development, inattention, bad behaviour, imbalance in toddlers and poor progress at school. The thick fluid has been shown in many cases to contain germs and predisposes the child to recurring attacks of middle ear infection and pain.
Hearing tests for children over the age of 3½ are available in the office when the children see Dr Dunlop.
To bypass the problems of the poorly functioning eustachian tube, a grommet (tiny tube) is placed in the eardrum after the thick gluey fluid has been removed. Most parents notice an immediate improvement in their children.
Using the microscope the procedure takes ten minutes though it may take ten to fifteen minutes for your child to go to sleep and again to wake up as this is done under general anaesthesia. Your child will only be in hospital for several hours but must be fasted for six hours prior to the anaesthesia.
Your child will be unaware of the grommet tube in the ear. Occasionally extra fluid drains for the first few days but this should settle with ear drops. If it does not, contact Dr Dunlop. Some children, especially under the age of 3, do not like ear drops. It is important to persist as the body is producing fluid in the middle ear even after the operation. The fluid may crystallize inside the grommet, blocking the grommet and preventing its purpose of ventilation.
If your child protests, warm the bottle of ear drops to body temperature by placing it in your armpit for two minutes before use. If this fails as well, give your child something sweet to suck after the administration of the drops as they may be able to taste the drops travelling through the ear, down the eustachian tube and then down the throat.
Most grommets remain in the eardrum for twelve months though this ranges from five to twenty four months. Eventually the grommet will drop out of the eardrum and in the wax. The hole in the eardrum heals spontaneously in almost all cases. Your child needs to be seen by Dr Dunlop one week after surgery and again every four months. After one set of grommets 80% of children have no further trouble though the remaining 20% will need a second set because of the ongoing eustachian tube problem.
There is good evidence to show that children with glue ear left untreated at a young age do not score as highly as disease free children five years later when measured for literary and numeracy IQ. The operation is important for the developing child but operations can be associated with complications. Fortunately, these complications are uncommon.
Infection: This may be caused by water soiling the grommet. Please ensure plugs are worn whenever near water i.e. bathing, showering and swimming. Water is not sterile. Infection is manifest by sticky smelly fluid in the ear canal. It should be treated immediately by Dr Dunlop. If it is the weekend, start the script for ear drops given to you on your first post operative appointment and see Dr Dunlop the first working day. The ear canal must be suctioned otherwise drops will sit on top of the pus in the ear canal. Sometimes, no matter how dry you keep the grommets, discharge develops. This is usually associated with a cold. The germs have travelled up the eustachian tube. Augmentin or Keflex syrup will be needed as well as the ear drops.
Perforation: This means a hole is left behind in the ear drum after the grommet is expelled. The risk is less than 2%.
Retention: Less than 2% of grommets get caught in the ear drum. We allow at least two and a half years for the body to push the grommet out of the ear drum naturally.
Rarer complications, such as those associated with any surgery on the ear, include hearing loss, tinnitus, imbalance, taste disturbance, CSF leak, meningitis, facial palsy and blood loss.
Remember to keep the ears dry. If your child duckdives in the pool they will probably develop infection and discharge.
Most grommets give no trouble. The children are unaware of them but must be taught to keep their ears dry.