Grommets for glue ear: what happens, risks and aftercare

Glue ear means sticky fluid sits behind the eardrum, muffling sound. It is common in young children, often follows colds or ear infections, and ENT UK notes that most cases resolve without intervention. Signs include turning the television up, not responding, delayed speech, balance problems or changes in behaviour.

For that reason a period of watchful waiting is the usual first step, often with advice on helping the child hear: face-to-face talking, clear speech and letting the nursery or school know. Grommets are considered when conservative measures are not enough.

They are not needed for every child with glue ear. A child whose hearing is only mildly affected and who is learning and talking well may simply be monitored with repeat hearing tests.

ENT UK lists hearing aids as an option when hearing is significantly affected, and nasal balloon therapy, in which the child blows up a balloon through the nose to improve ventilation of the middle ear. Neither involves an operation or anaesthetic, though they depend on the child cooperating.

In older children the decision can reasonably involve the child too. Some families accept hearing aids to avoid an anaesthetic; others prefer a single short procedure.

The child will be asked not to eat or drink for a set time before the anaesthetic, with instructions from the hospital about fasting for younger children. At the day unit the child is checked, may be given a play session, and goes to theatre with a parent to the anaesthetic room.

Under the general anaesthetic the surgeon makes a tiny cut in the eardrum, sucks out the fluid and places a grommet in the opening. The procedure is quick and the child wakes soon afterwards in recovery. ENT UK notes a day or two off school may be needed.

The ENT UK decision aid sets out figures: hearing improves in 9 of 10 children with glue ear; 16 of 100 have ear discharge in the first two weeks; 22 of 100 have later discharge that needs treatment, usually antibiotic eardrops; 4 of 100 have discharge severe enough that the grommet is removed; and 4 of 100 are left with a small hole in the eardrum that might need repair.

Rare problems include damage to a tooth from the anaesthetic airway tube. The usual anaesthetic risks are explained by the pre-assessment team.

Minor earache is common and can be managed with paracetamol. A little fluid from the ear for a day or two is normal. ENT UK recommends protecting the ears from water until the grommets are out, using a cotton wool ball with Vaseline when washing hair and earplugs for swimming; its advice is to avoid dirty bathwater and not to dive deeply.

Because the grommet will eventually fall out, the ear drum heals over, and follow-up hearing tests check whether the effusion has returned.

• Fluid from the ear that continues or smells, or fever: contact your GP or ENT team.

• A grommet visible in the ear canal usually just means it is working its way out.

• Persistent ear discharge that does not clear within a few days.

• Increasing pain, a high temperature or the child seeming unwell.

• Hearing that gets worse again after the grommets fall out.

• Any bleeding that does not settle.

• How much is the glue ear affecting my child's hearing, and for how long has it persisted?

• Would repeat testing or a hearing aid be reasonable first?

• What are the water rules for my child, and for how long?

• What follow-up is arranged?

Criteria on the NHS usually require glue ear to persist across repeat hearing tests over a period of months. Private care may allow earlier surgery, but the clinical reasons should still apply. Ask whichever route you use how follow-up hearing tests are arranged after the operation.