Childhood Ear Problems & Grommet Surgery

“Ear infections” are a common cause of concern – and confusion – in childhood, and trouble families in three main ways.

1. The “quiet, deaf” ear infection may be completely painless but present with a child who is inattentive, ‘ignorant’, or who turns the television up very loudly. They may be slow to learn to speak or have trouble pronouncing words clearly. Teachers may raise concerns, or you may find your child more difficult to engage with at home.
2. The “painful, acute” ear infection often presents with fevers and ear pain – frequently in the middle of the night. Occasionally, a burst ear drum with bloody discharge occurs.
3. The “swimmer’s ear” ear infection often presents with a sour-smelling, ‘runny’ ear– this is a essentially a skin infection, but because of the unique shape and characteristics of the ear canal, established infections can be surprisingly difficult to treat without specialist equipment and medication

Childhood illness effects the whole family, through sleep disruption, behavioural disruption, time off work and school, and cross infection. At Evolve, our ENT surgeons will help determine the exact cause of your child’s ear troubles, establish their hearing level and help you restore good health to your child, your family and home.

On the day: On the morning of your child’s grommets, you will follow the fasting instructions you have been given. Depending on the time of operation, these will either have your child ‘Nil By Mouth’ from midnight, or may allow them sips of clear fluid up to a certain time in the morning. You and your child will present to the hospital area listed in your paperwork for check in – you’ll answer some questions and have some basic health checks. Most hospitals allow children to wear their own pyjamas, but sometimes a gown will be provided. A favourite cuddly toy can usually come along for the ride and as there will be some waiting involved, it’s a good idea to bring an activity, such as a book, iPAD or tablet, for kids to occupy themselves.

Time to go: In elective cases, your child’s support person (usually Mum, Dad or carer) comes along with them to the anaesthetic room, where you’ll meet more of our team. It’s normal for children to be nervous about new experiences – they will look to you for a clue as to how they should be feeling. Kids whose carers keep it cheerful and upbeat (on the surface at least!) are happier going to sleep, and wake up more smoothly… Of course it’s normal for you to be nervous too (shedding some tears after your child goes to sleep is common!) but our caring team will be there to support you and guide you back to the waiting area.

Going to sleep: Small children usually drift off to sleep using a mask. Bigger children occasionally need a small needle to go to sleep safely. To make this comfortable, we use a numbing jelly on the skin before hand.

General anaesthetics are extremely safe. Like all things in life, there are some risks, and you will discuss these with your anaesthetist on the day. In Australia, serious risks exceptionally rare – and comparable to other risky things we do everyday, like driving in a car. Our surgeons have world-class training and expertise – as well as families of our own. Your child’s comfort and safety is our utmost priority. While they are in our hands, we will treat them like our own – right up until we return them to yours.

The Operation: Once your child is asleep and all monitoring equipment is attached, your child will have the ear canals cleaned and the state of the ear will be examined using a microscope. Any features of note will be documented and the integrity of the eardrum – as well as the ideal place to situate the grommet – will be determined. A tiny cut will be made using microscopic instruments, the middle ear will be cleared of secretions. A ventilation tube (grommet) will be carefully placed to hold the edges of this vent open while your child’s middle ear health slowly improves over the coming months.

Afterward: While emerging from their sleep, your child is cared for by our expert recovery nurses. When they are awake enough to ask for you, you’ll be brought to their side so you are available for cuddles and comfort as they wake. Sometimes, children are groggy and confused after an operation – this is normal, and it will pass. Children having grommets inserted do not usually complain of much pain – a little blood-stained discharge is quite common on Day 1, this can simply be wiped away. Children often complain their hearing is ‘too loud’ on the trip home, but they will get used to being ‘back to normal’ very quickly.

Grommets fall out according to their own timeline, and this depends on a number of factors including the type of grommet used and the state of the ear-drum and middle ear. Some families find their child’s grommets are easier to look after when kept dry. Others find they can bathe and swim freely, with no increase in ear infections. If your child does better with ‘water precautions’, here are a few handy hints for keeping the ears dry.

KEEPING YOUR EARS DRY:

• For bathing:
  • A shower cap over the ears can be used if not washing the hair
  • A prune-sized wad of blu-tak moulded into the outer ear is useful for showers, or bath-time play. Vaseline on a cotton ball can also be used
• For swimming:
  • Special “sized” ear plugs, a headband and a bathing cap provide “three layer” protection for patients prone to water-borne infections
  • We recommend fitted Doc’s Pro-Plugs or custom-made plugs for a snug fit – these can be obtained from Attune Audiology Kawana, or Neurosensory Unit Buderim
• If the ear gets wet:
  • Shake out the excess water with the head on tilt
  • Dry mop the outer ear
  • A hair dryer on cool setting held at arms length can be helpful

• If the ear discharges:
  • A little clear or blood-stained discharge is normal after your grommets are put in. Simply twist a corner of a tissue into a ‘spear’ and wipe the canal clear as required. This may need to be done every couple of hours for the first day

If the ear develops smelly or copious discharge that does not settle with dry mopping over a couple of days, please see your GP for ear drops (ciprofloxacin + hydrocortisone) to use for 5-7 days. These are safe to be used with grommets.

FOLLOW-UP

• An early “grommet check” will be performed around two weeks after your surgery
• You will then be reviewed on roughly six-monthly intervals – sometimes with a hearing test – until the grommet is out, the ear has healed and your condition has stabilised
• Most people require only a single set of grommets. However, some people require treatment and follow-up over several years. Your Evolve ENT will guide you as to what you require to maintain your best ear health.