Post-operative care following the insertion of middle ear ventilation tubes (grommets).

 

Grommets are inserted as a day stay procedure and usually you or your child will be fit to go home approximately 2 hours after surgery. Occasionally for 24 hours or so after the operation you will notice a slightly bloodstained discharge from your child's ear. It is not concerning and can simply be wiped away with a cotton bud. Often patients are started on an antibiotic eardrop known as ciloxan for about five days after surgery, usually four drops twice daily to each ear commencing on the evening of the day of surgery. Whether or not your child is commenced on these eardrops will depend on the amount and nature of the fluid seen in the middle ear at the time of surgery. To place the drops lie your child on their side and gently pull the ear upwards and backwards which opens up the ear canal. Drop the drops into the ear canal and then gently pumped the tragus (the small flap of cartilage in front of the ear canal) for approximately 30 seconds to pump the drops down the ear canal. Your child may comment of an abnormal taste in the mouth. This is quite normal and simply represents the drops moving down the Eustacian tube. If both ears need to be done leave your child lying on the side for a minute or so before turning them over and doing the other ear. Store the drops in your refrigerator.

 

Grommets are very effective in restoring hearing in children who are suffering from hearing loss due to middle ear fluid and often you may notice even before leaving hospital that your child’s hearing has improved.

 

If your child is experiencing pain following grommet insertion usually Panadol is all that is required to treat it. It is permissible to use nurofen as an alternative.

 

A child can return to daycare, preschool or school on the day after surgery. They can play sport but should not go swimming for 2 weeks after surgery.

 

While the grommets are in it is important to protect the ears from water. When bathing your child keep their head out of the water. To wash their hair smear some vaseline over a small cotton ball and gently use this to plug the ear. Then you can tip water over their head to wash their hair. As an additional protective measure or in the case of children who will not tolerate anything in the ears a hair wash visor can be used which is obtainable from larger baby stores. This looks like a tennis visor and will protect the child ears when washing their hair. If you think that water has gone in your child's ear then simply gently pull the ear up and back and use your hairdryer from approximately 50 cm away for a minute or so to blowdry the ear.

 

Children are allowed to swim (including jumping in the pool and going underwater) after grommets have been in place for two weeks but they do have to protect the ears from water while grommets are in. Two layers of protection are required. Firstly an earplug and secondly a swimming cap or swimming headband. Bluetac can be used or alternatively silicon earplugs purchased at the chemist but a better options are either a pro-plug or a custom moulded earplug both which are available from my Miranda practice. You would need to ring the office and make an appointment to see our audiologist Jane or Rebecca such that these can be fitted. Likewise children's swimming headbands are available.

 

Apart from this there are no restrictions on a child activities with grommets in place. Grommets will actually help if your child needs to go in an aeroplane as they will perform the pressure equalising for the ear. Contact sports are permitted a week after grommet insertion.

 

It is possible to develop an ear infection while grommets are in place. In this instance the child may develop an earache and/or a discharge from the ear. If this happens contact the Miranda office and I or one of my colleagues (if I am not in the office that day) will endeavour to see your child that day such that the ear can be cleaned and appropriate antibiotic eardrops and possibly oral antibiotics will be commenced. In general with antibiotic eardrops ear infections with grommets tend to settle quite rapidly.

 

Your first post-operative appointment following grommet insertion will be at one month after surgery and subsequent appointments will be at four monthly intervals until the grommets have left the eardrums. The average time for this to occur is approximately 12 months. If the grommets have discharged from the eardrums then occasionally you may see a grommet in the outer part of the ear canal. It is usually a small black tube and if seen in the outer ear could be gently plucked away with a pair of tweezers. You may indeed notice a grommet on your child's pillow. It is not concerning if the grommet comes out and indeed the natural history is that the eardrum will discharge the grommet.

 

You will have been provided in College of Surgeons information brochure regarding treatment with grommets. This does have useful information regarding post-operative care. Your child will undergo a hearing assessment following grommet insertion. This may be arranged early after grommets have been inserted but often will not be performed until after the grommet has left the eardrum if your child is progressing well with their speech (and in older children their reading ) development.