Grommet insertion for glue ear (adult)

About grommet insertion

A grommet is a small plastic or metal tube that we surgically insert into your ear.  

We usually recommend surgical grommet insertion to treat glue ear (see below).

We also recommend it to give medicine and to help relieve symptoms of Ménière's disease, which can affect your balance and hearing.

After 6 to 18 months, the grommet falls out of the ear by itself. The length of time it remains depends on the material and design of the grommet.

About glue ear

Glue ear is a common condition whereby fluid collects behind your eardrum, in your middle ear. Glue ear can cause deafness, earache and infection. It can sometimes cause discharge from your ear.

Glue ear almost always gets better. However, if it continues for a long time (months or years), it can weaken your eardrum and affect the hearing bones in your middle ear.  This can result in frequent ear infections and long-term damage to your hearing.

We usually recommend surgical insertion of grommets if your glue ear continues for more than 3 months and is causing you hearing problems or repeated ear infections.

Causes

There is not always an obvious reason for glue ear. Sometimes it can follow if you have a cold or have radiotherapy to your neck. 

It can also be caused by an underlying tumour in the back of the nose. This is rare.

Alternatives to surgery

Many people who have glue ear do not need surgery.

If you have glue ear, your healthcare professional may suggest you wear a hearing aid until your hearing improves.

Preparing for the procedure

To prepare for the procedure, do the following.

• Try to quit smoking. This may reduce your risk of developing complications after the procedure. 
• Maintain a healthy weight. If you are overweight, you have a higher risk of developing complications.
• Take regular exercise. This will help to prepare, recover and improve your health long-term. Ask your GP or healthcare team for advice on a suitable exercise plan.

The procedure

We will not carry out the procedure unless we have your written consent.

We usually perform the grommet insertion procedure while you are under general anaesthetic (asleep), but sometimes we use a local anaesthetic.  Your anaesthetist will discuss options with you.

If you have glue ear, your surgeon will make a small hole in your eardrum and remove the fluid by suction. They will place a plastic or metal grommet in the hole. The choice of material depends on how long the grommet will stay in place.

The procedure usually takes about 20 minutes. It is usually pain-free.

Patients usually go home the same day. Sometimes the doctor recommends an overnight stay. 

To reduce the risk of blood clot, follow your healthcare team's instructions on medicine or wearing special stockings.

Recovery after discharge from hospital

If we have given you sedation during your procedure, for the first 24 hours you must not:

• operate heavy machinery
• drive any vehicle
• undertake potentially dangerous activities (including cooking)
• consume alcohol
• sign legal documents.

When you shower or bath, try to keep your ear dry because soapy water can cause an ear discharge. Do this for 2 weeks.

After this period, you may swim and get back to all activities. There is still a small risk of infection if water is allowed to remain in your ear afterwards.

Consult your GP if your ear leaks. They may prescribe topical (applied to the body) antibiotic ear drops.

To prevent water getting into your ear, you may need to consider wearing ear plugs or obtaining swim moulds from the Kingston Hospital Audiology Department.  (There is a small fee payable to custom fit and manufacture these moulds).

Benefits and risks

Benefits

The grommet allows air to enter your middle ear, preventing fluid build up which can cause deafness.

The grommet does not treat the underlying cause of glue ear, so when the grommet falls out, your glue ear may return.

Risks

In the days after surgery

• Discomfort. It is normal to have some discomfort, including pain, irritation, or stiffness, for a few days or weeks. We will discuss pain relief options with you.

• Ear infection. It may cause earache, a high temperature and sickness, and sometimes difficulty with hearing or balance. We can treat this with antibiotic drops in the ear.

• ​​​​Bloodstained ear discharge. Small amounts of fluid can leak from the ear following surgery, and this can contain blood. It usually settles after a few days.

In the months or years after surgery

• Ongoing symptoms (common: more than 1 in 20 patients). Despite the procedure, symptoms may continue and we may recommend further tests or treatments. Around 1 in 10 patients will have intermittent (on and off) symptoms despite having grommets inserted. Repeated severe infections can occur, which require the grommets to be removed, but this is rare. After grommet insertion, around 1 in 5 patients need a second set, due to glue ear returning after the grommet has fallen out. 
• Persistent eardrum perforation, where there is a hole in the eardrum that does not heal (less common: fewer than 1 in 20). After being put in, most grommets fall out between 12 to 24 months later, and the eardrum usually heals. A small number of patients (up to 2 in 100) have a persistent perforation of the eardrum, but it is rare for patients to need surgery to close it. 
• Grommet falls out early (rare: fewer than 1 in 100). If this happens we often need to re-insert further grommets. 
• Retained grommet (rare: fewer than 1 in 100). The grommet may not fall out by itself and we may have to remove it.
• Scarring of eardrum caused by repeated ear infections (rare: fewer than 1 in 100). Over time this can lead to problems with hearing. Grommets leave a hole in the eardrum which heals over time and can also leave a scar. It can lead to problems with hearing but this is rare.