Understanding Middle Ear Infections and the Treatment of Grommets



Understanding Middle Ear Infections and the Treatment of Grommets

Until you had children, you may have thought a grommet was a small coastal dwelling child who swam out with the local surf lifesaving club. However, more seriously, grommets are an effective treatment for long-standing middle ear infections in babies and children.

At any given time one out of every three primary school age children will have some form of middle ear condition.

Insertion of grommets (or tympanostomy tubes) is the most common ambulatory surgical procedure performed on children in Australia. It accounts for about twenty percent of day surgical procedures.

By the age of three, it is estimated one out of every fifteen children (6.8%) will have grommets.[1]

The two types of ear infections commonly seen in children are middle ear infection (otitis media) and outer ear infections (otitis externa).

Causes of Middle Ear Infections in Babies and Young Children

Most ear infections involve the middle ear.

Babies and young children get more middle-ear infections than older children because the tubes (called the Eustachian tubes) that connect the middle ear to the throat are smaller. This makes it easier for germs to reach the middle ear from the nose and throat during head colds, which are very common in small children[2] and can cause the build-up of sticky fluid that can affect hearing or even speech.

Middle ear infection is also known as otitis media or glue ear in children.

Signs and symptoms of middle ear infection or glue ear

Symptoms of otitis media usually include earache and fever. Other symptoms may include irritability, restlessness and disrupted sleep. Because many cases of otitis media are caused by a viral infection, there are often other symptoms associated with the infection, such as a sore throat, runny nose or a cough.

In the first instance, ear infections are generally treated with antibiotics to try and resolve the infection causing the problem. However recurrent infections need more serious medical treatment.

Recurrent otitis media is defined as three or more separate episodes of acute otitis media within a 6-month period.[3]

Recurrent acute otitis media can cause a range of serious medical problems including negatively affecting speech and learning, balance and coordination and can cause long term damage to ear drums.

When are grommets recommended?

Serious medical treatment of persistent and recurrent acute otitis media may be needed to help your child move past the negative affects it may be having on their development.

Grommets may be recommended if your child has glue ear that won't clear up, or frequent ear infections. The grommets will significantly improve hearing and reduce the incidence of acute otitis media.

Grommets create a small opening in the eardrums. This allows the glue-like fluid in the middle ears to be cleaned out so that the ears can return to normal.

Grommets, also called tympanostomy or ventilation tubes, are tiny plastic tubes which are inserted into a small slit in your child's ear drum in a short operation. A grommet itself is often just one 1 – 2mm in diameter and once inserted will not cause any discomfort to your child.

Grommets can be made of plastic or metal. They don’t hurt. They allow air to enter the middle ear and drain the fluid to the back of the nose and throat.[4]

Grommets usually fall out naturally within 6 to 12 months, leaving the eardrum unharmed.

Surgery for grommets

The surgery to insert grommets is called myringotomy. It takes about 15 minutes and is done under general anesthetic, so your child won’t feel anything. The grommets are inserted through the ear canal - there are no cuts made on the outside.

Hearing is generally restored quickly afterwards.

One of the complications of grommets is ear infection, so it is best to keep the ears dry. Your child should avoid swimming for a week after the surgery and while the grommets are in place use earplugs when bathing, showering and swimming.

Children usually are not aware of the grommets being in place.

Dr Indu Gunawardena performs children's grommet insertion at Gosford Private Hospital, Berkeley Vale Private Hospital and Gosford Public Hospital.

To learn more, contact us to make an appointment with Dr Indu. 

[1] Otitis media (revised June 2010). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2012 Nov. (accessed Feb 2013).

[3] Ear infection (middle ear) (updated 14 Apr 2011). (accessed Feb 2013).