grommet

Grommets are small ventilation tubes which are inserted in the ear drum for conditions like Otitis Media with effusion(OME) and Eustachian tube dysfunction (ETD).

In simple words OME means presence of glue behind the ear drum due to eustachian tube dysfunction in children’s and adults. If OME persists for more than 2 to 3 months then it is mandatory to insert the grommets in the ear drum.

It can be done under Local anesthesia and General anesthesia. Under Local anesthesia (commonly in adults) it takes not more than 20 minutes for the complete procedure. Under General anesthesia child will be coming in the morning fasting for 6 hours and will be discharged in the afternoon.

What is glue ear?

Glue ear is a Common condition where fluid” collects in the middle ear behind the eardrum It Can cause deafness and repeated earache or infections, resulting in discharge from the ear.

Your surgeon has recommended inserting a grommet (Small plastic or metal tube) to treat your Glue ear. However, it is your decision to go ahead with the operation or not. This document will give YOU information about the benefits and risks to help You make an informed decision. . if you have any questions that this document does not answer, you should ask your surgeon or any member 0f the healthcare team.

How does glue ear happen? A tube, called the eustachian tube, connects the middle ear with the back of the nose. The eustachian tube allows air to reach the middle ear so that the pressure behind the eardrum stays the same as the pressure in the air around the head. Sometimes this tube does not work properly. This causes fluid to build up in the middle ear. This collection of fluid is called glue ear.

Glue ear is common in children and happens fairly frequently in adults. Sometimes there is no obvious reason why it happens, but it can follow a cold or radiotherapy to the neck. Most adults with glue ear get better without ever seeing a doctor. However, in some people it can continue for several months or years.

What are the benefits of surgery?

The grommet allows air to enter the middle ear, preventing fluid build-up and the resulting deafness. The grommet does not treat the actual cause of glue ear, so when it falls out the glue ear may return.

Are there any alternatives to surgery?

Many people with glue ear do not need surgery. The condition will almost always get better by itself. However, it is not always possible to say when this will happen. Your surgeon (or audiologist) will almost certainly have observed you for at least three months to see if the glue ear has improved.

Surgery is recommended if the glue ear continues for longer than three months and is causing problems with poor hearing or repeated ear infections. If the glue ear continues but there are no other obvious problems, it is safe and reasonable to observe the condition for much longer than three months.

What will happen if i decide not to have the operation?

Glue ear will almost always get better by itself so there are no serious risks associated with not having the operation. Another treatment is to wear a hearing aid until hearing improves.

What does the operation involve?

Grommet insertion is usually performed under a general anaesthetic but a local anaesthetic can be used. Your anaesthetist will discuss the options with you and will recommend the best form of anaesthesia for you. The operation usually takes about twenty minutes. Your surgeon will make a small hole in the eardrum and remove the fluid by suction. They will then place a plastic or metal grommet in the hole. The choice of material depends on how long the grommet should stay in place.

What can I do to help make the operation a success?

  • Lifestyle changes

if you smoke, try to stop smoking now. Stopping smoking several weeks or more before an operation may reduce your chances of getting complications and will improve your long-term health.

For help and advice on stopping smoking, go to www.gosmokefree.co.uk.

You have a higher chance of developing complications if you are overweight.

For advice on maintaining a healthy weight, go to www.eatwell.gov.uk.

  • Exercise

Regular exercise can reduce the risk of heart disease and other medical conditions, improve how your lungs work, boost your immune system, help you to control your weight and improve your mood. Exercise should help to prepare you for the operation, help with your recovery and improve your long-term health.

For information on how exercise can help you, go to www.eidoactive.co.uk.

Before you start exercising, you should ask a member of the healthcare team or your GP for advice.

What complications can happen?

The healthcare team will try to make YOU’ operation as safe as possible. However, complications can happen. Some of these can be serious. You should ask your doctor if there is anything you do not understand. Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you.

The complications fall into three categories.

  1. Complications of anaesthesia
  2.  General complications of any operation
  3.  Specific complications of this operation

• Complications of anaesthesiaYour anaesthetist will be able to discuss with you the possible complications of having an anaesthetic

• General complications of any operation

Pain, which happens with every operation. Placing a grommet in the ear is not a painful procedure and even most children do not complain of pain after the operation.

Bleeding during or after surgery, noticed as a small amount of blood leaking from the ear for a day or two after the operation.

• Specific complications of this operation

Leaking from the ear of clear fluid or fluid mixed with blood for a day or two after the operation. This usually settles without any treatment.

Ear discharge lasting longer than a day or two (risk: 1 in 7 for normal grommets, 1 in 3 for special T-shaped long-lasting grommets). You may need antibiotic ear drops to settle this down. Your GP should be able to prescribe these for you. Sometimes the grommet will need to be removed (risk: less than 1 in 100 for normal grommets, 1 in 8 for SPGCla’ T-shaped long-lasting grommets).

Small hole left in the ear drum after the grommet falls out (risk: 2 in 100 for normal grommets, 25 in 100 for special T-shaped long-lasting grommets).

Repeated build-up of fluid in the middle ear, caused by the grommet becoming blocked with blood of wax before it falls out.

How soon Will I recover?

  • In hospital

After the Operation you will be transferred to the recovery area and then to the ward. You should be able to go home the same day. However, your doctor may recommend that you stay a little longer. If You do go home the same day, a responsible adult should take you home in a car or taxi, and stay with you for at least 24 hours. You will need support for a few days.

If you are worried about anything, in hospital or at home, ask a member of the healthcare team. They should be able to reassure you or identify and treat any complications.

  •  Returning to normal activities

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, you should ask a member of the healthcare team or your GP for advice.

Do not drive for at least 24 hours after the operation and not until you are confident about controlling your vehicle. Always check with your doctor and insurance company first.

You should try to keep your ear dry and do not go swimming for six weeks. Other than swimming, you should be able to return to normal activities after 24 hours.

The future

The grommet will fall out of your ear by itself, after nine to twelve months for the plastic type and after about two years for the metal type. When this happens the glue ear may return. This depends on whether the middle ear and eustachian tube have recovered their normal function while the grommet was in place. The actual grommet does nothing to help this, only acting to prevent fluid from building up.

 Summary
 
Glue ear is a common condition that usually gets better without any surgery. Surgery is recommended when the condition lasts longer than three months and the hearing loss is causing problems. Surgery is usually safe and effective. However, complications can happen. You need to know about them to help you make an informed decision about surgery. Knowing about them will also help to detect and treat any problems early.

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