Grommets for glue ear, by a consultant ENT surgeon.
Private ventilation tube surgery for children with persistent glue ear and for adults with refractory eustachian tube dysfunction - with audiology first, NICE CG60 as the pathway, and hearing improvement usually on the same day.
Reading US guidance? Our companion page on ear tubes covers the same procedure in North American terminology.
Indicative pricing
What private grommet surgery costs in London.
Indicative ranges across UK private providers - audiology and fitting included.
In short
Bilateral grommets in a child under GA: £1,600–£2,600, home the same day.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| Grommet insertion - child, under GA | £1,600–£2,600 | 20–30 min | Same day |
| Grommets + adenoidectomy - child, under GA | £2,400–£3,800 | 30–45 min | Same day |
| Grommet insertion - adult, LA | £900–£1,600 | 15–20 min | Same day |
| Grommet insertion - adult, GA | £1,800–£3,000 | Half-day | Same day |
| Long-stay T-tube (recurrent OME) | £1,900–£3,200 | 20–30 min | Same day |
| Consultation + audiology + tympanometry | £250–£450 | 45 min | Same visit |
Prices vary by clinic, by which ENT surgeon does the case, by anaesthetic, and by whether adenoidectomy is added.
The problem
Audiology first. Then, if needed, surgery.
Too many children are booked for grommets without a proper audiogram - and too many adults with one-sided glue ear are given a tube without a nasendoscopy. We fix both, before you commit.
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Is the hearing loss real and persistent?
Two audiograms three months apart, with a Type B tympanogram - the NICE CG60 evidence base for surgery.
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Is watchful waiting still the right call?
Most glue ear settles in three months. We say when it is time to move - and when it is not.
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Adult unilateral OME - investigated first?
Nasendoscopy, always. Up to five percent of adults with unilateral glue ear hide a nasopharyngeal cancer.
When it helps
When grommets are the right step.
The situations we see most, plus the one red flag in adults that means investigation before any surgery.
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Glue ear in children (OME)
Persistent middle-ear effusion with hearing loss - the commonest reason for grommets in the UK.
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Hearing loss affecting speech or school
Bilateral 25–30 dB loss over three months, confirmed on two audiograms, is the NICE CG60 threshold to refer.
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Down syndrome or cleft palate
Earlier referral is standard - the eustachian tube anatomy makes OME more likely and more persistent.
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Recurrent acute otitis media
Repeated painful ear infections despite antibiotics - grommets ventilate the middle ear and cut infection rates.
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Adult refractory eustachian tube dysfunction
Blocked, popping ears that will not clear despite decongestants, steroid sprays and autoinsufflation.
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Recurrent barotrauma
Cabin crew, divers and frequent flyers with repeated ear pain and effusion on descent.
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Persistent adult OME
A middle-ear effusion in an adult that has not cleared with conservative treatment - after nasopharyngeal cancer is excluded.
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Red flag: unilateral adult OME
A one-sided middle-ear effusion in an adult must have a nasendoscopy first - up to 5% hide a nasopharyngeal cancer.
Procedure options
Grommets - and the alternatives.
What each option on the table actually involves - from short-stay Shepard tubes to long-stay T-tubes, balloon tuboplasty and hearing aids.
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Short-stay grommet (Shepard / Armstrong)
The standard silicone or fluoroplastic tube. Extrudes on its own in six to eighteen months - the default first-time choice.
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Long-stay T-tube (Goode / Paparella)
A T-shaped tube that stays in for years. Used for recurrent OME, Down syndrome and cleft palate, or after a second short-stay set has extruded early.
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Grommets with adenoidectomy
For children over four with recurrent OME - the TARGET trial showed adenoidectomy at the same procedure reduces re-insertion rates.
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Bilateral grommets
Both ears done at the same visit under one anaesthetic - the norm for paediatric glue ear, which is nearly always bilateral.
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Adult LA grommet
A cooperative adult can have a single grommet placed under local anaesthetic with topical adrenaline - awake and home in an hour.
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Balloon eustachian tuboplasty
A non-grommet alternative for adults with eustachian tube dysfunction (NICE IPG573) - dilating the tube rather than bypassing it.
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Hearing aid instead of surgery
For mild hearing loss, or where surgery is declined, a well-fitted hearing aid is a legitimate alternative - especially in children with syndromes.
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Consultation only
An honest discussion of whether surgery is needed at all - often the answer is watchful waiting for another three months.
Safety and recovery
What to expect afterwards - honestly.
Grommet insertion is one of the commonest paediatric ENT procedures. The things worth planning are water precautions, the six-week audiogram, and knowing what is normal after.
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Watchful waiting is not neglect
NICE CG60 recommends three months of observation before surgery in most children, unless hearing loss is severe or a syndrome makes early intervention right.
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Transient otorrhoea is common
A small amount of discharge in the first 24–48 hours is expected. Ten to twenty percent of children have a further episode over the life of the grommet - treated with drops.
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Keep water out - the conventional advice
Swimming caps or moulded plugs for bath, pool and shower is the traditional advice. The evidence is genuinely mixed, but most surgeons still recommend it.
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Extrusion after six to eighteen months
Grommets fall out on their own as the eardrum grows. In most children the drum heals; a small persistent perforation happens in one to two percent.
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Tympanosclerosis is cosmetic
Small chalky white patches on the eardrum after grommets are common and do not affect hearing - they are a scar, not a problem.
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A second set is often needed
About thirty percent of children with glue ear need a second set of grommets. It is not a failure - it is the natural history of the condition.
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Adult unilateral OME - nasendoscopy first
A one-sided middle-ear effusion in an adult must have the nasopharynx inspected before any grommet. A missed nasopharyngeal cancer is the worst outcome.
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Post-op audiogram at six weeks
A repeat audiogram confirms the hearing gain - typically 15–20 dB. If hearing has not improved, the tube may be blocked and needs review.
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Red flags
Persistent bleeding, spreading facial swelling, high fever or sudden severe pain after surgery are not normal - call the clinic or A&E the same day.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever tube was used, the note the ENT surgeon sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the note before the six-week audiogram, just ask.
- 01 Header
Indication and ear(s) treated
Why the procedure was done - glue ear, recurrent AOM, adult ETD - and which ear or ears had grommets inserted.
- 02 Technique
Anaesthetic, myringotomy and tube type
Whether LA or GA was used, the position of the myringotomy, and which grommet was placed (Shepard, Armstrong, Goode T-tube).
- 03 Findings
Effusion, adenoids, nasopharynx
What was in the middle ear (serous, mucoid, glue), whether adenoidectomy was done, and - in adults - the nasendoscopy findings.
- 04 Impression
Aftercare, water advice, follow-up
Read this first: water precautions, expected hearing change, when to return, and the timing of the six-week audiogram.
Recognised by major UK insurers
Cover for grommet insertion varies by insurer and by indication - usually funded for paediatric glue ear with documented hearing loss, and for adult cases with a specialist referral.
Frequently asked
Everything we get asked about grommets for glue ear.
Quick answers on NICE thresholds, anaesthetic, cost, water precautions, and what happens if grommets fall out.
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What are grommets and how do they work?
Grommets are tiny silicone or fluoroplastic ventilation tubes placed through the eardrum at the anterosuperior quadrant. They ventilate the middle ear so the fluid of glue ear can drain and the pressure equalises - hearing usually improves the same day.
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When does my child actually need grommets?
NICE CG60 recommends grommets for bilateral glue ear with hearing loss of 25–30 dB or more, confirmed on two audiograms three months apart, when it is affecting speech, learning or development. Children with Down syndrome or a cleft palate are referred earlier.
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Are grommets done under general anaesthetic?
For children, yes - a short GA via a laryngeal mask, taking fifteen to thirty minutes for both ears. Cooperative adults can have a single grommet placed under local anaesthetic with topical adrenaline, awake and home in an hour.
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How long do grommets stay in?
Short-stay grommets - Shepard or Armstrong - extrude on their own as the eardrum grows, usually between six and eighteen months. Long-stay T-tubes (Goode, Paparella) stay in for years and are used for recurrent OME or in children with Down syndrome or cleft palate.
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Can my child swim with grommets in?
The conventional advice is to keep water out of the ear - swimming caps or moulded plugs for the pool, shower and bath. The evidence is genuinely mixed and some surgeons are relaxed about it, but most still recommend caution, especially with soapy water and diving.
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How much does private grommet surgery cost in London?
Roughly £1,600–£2,600 for bilateral grommets in a child under GA, £2,400–£3,800 with adenoidectomy at the same time, £900–£1,600 for an adult LA grommet, and £1,800–£3,000 for an adult under GA.
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What happens if the grommets fall out and the glue ear comes back?
About thirty percent of children need a second set of grommets - this is normal, not a failure. If a second set has already extruded and the OME persists, a long-stay T-tube is the usual next step.
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What is the difference between grommets and ear tubes?
They are the same thing. "Grommet" is the UK term; "ear tube" or "tympanostomy tube" is the North American term. If you have been reading US guidance, our companion page at /treatments/ear-tubes covers the same procedure in that terminology.