Advice when a child going for grommet surgery

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The preferred option for treatment of glue ear in typically developing children, as advised by clinical guidelines, is to insert grommets. There are tiny plastic ventilation tubes. To put the grommet in a cut is made in the ear drum. This requires an operation under general anaesthetic. This is usually done as day surgery, but it can mean an overnight stay in hospital for the child. The child can be accompanied by an adult staying overnight.

Although this is the first choice for treatment there are other options. I will write a separate blog about hearing aids. Should grommet surgery be the choice then there are some choices that you have and things that are worth preparing for to make this a positive experience for the child.  Do make sure that you talk to the staff on the pre-visit about your wishes and options.

Because grommet insertion is the most common reason children go into hospital and thousands of such operations are performed every year, then it is easy for healthcare professionals to forget to explain the procedure in detail to parents. It is important that someone tells the child what is going to happen and for the parent/carer to be aware of somethings which they need to discuss and think about before the operation so that everyone can be well prepared. This video is worth watching https://www.youtube.com/watch?v=Un3EVzBNWNE

Please make the time to explain clearly to the child what is going to happen during the surgery and at the hospital. Children can imagine all sorts of things if they do not know what is happening. Even young children are capable of understanding more than adults think they do. If possible a picture of the inside of the ear and letting the child explain back what they think is happening is really useful.

In most hospitals, the assumption is that the child will have a cannula put in their hand after some numbing cream (often called ‘magic cream’) is applied. If a child is afraid of needles then he/she should be given the option to have a mask put over his/her face through which he/she will breathe gas.  This may make the child struggle, but can be better for some children. Parents/carers can accompany the child down to the theatre. This helps to ensure the child remains relaxed. Do ask for this to happen.

When the child comes around from surgery, there will be a short period of time when the parent/carer will not be with him/her.  To help keep the child calm then give a favourite toy or comforter, which has been washed and wrapped in plastic, to the theatre staff before the operation.  This way the child will have it and the familiarity can reassure him/her before the parent/carer is there.

The child is not usually released from hospital until they can keep food down. If you have a drink or snack that the child likes, this makes things easier. Children react to anaesthetics in different ways. Some can become very hyperactive, others sleepy or grumpy and some vomit. Unless your child has previously had an anaesthetic, no one can predict the behaviour.

If only grommet surgery has been performed then the child is likely to have no pain. The length of time that grommets remain in the ear drum differs from child-to-child. They should stay in for about 9 months, but it can be as short as a month. They usually appear in a ball of wax that is pushed out through the ear canal.

Do ask me any questions you may have.

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Glue Ear – Something every parent should know

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Glue Ear warning signs

One of the first signs that many parents report is that their child is pulling their ears or putting their hands over their ears. Some children have a nasty smelling discharge from their ears and this is usually an indication of the ear drum having being perforated. For other children there is no pain, but their hearing is not as it usually is. This can lead to a change in sleep pattern and general grumpiness. It could be that the child is not responding. The first action is to see your GP. If there is an infection and/or discharge, then antibiotics may well be prescribed, some GPs do not. If your child is in pain then give them the recommended dose of a pain relief medicine.

The National Deaf Children’s Society www.ndcs.org.uk  has a booklet that can be downloaded about Glue Ear. You have to join, but it is free and gives you access to their publications.

Glue Ear happens when there is a build-up of sticky fluid (which is often like glue and so the name Glue Ear). This happens in the middle ear which should be full of air. Sound normally enters the ear through the ear and goes down the ear canal before reaching the ear drum. The sound waves should then pass over some very small bones in the middle ear causing them to vibrate. In the middle ear there is also a connection to the back of the throat, the Eustachian Tube. This helps to keep the pressure even on both sides of the ear drum. If there is fluid in the middle ear then the sound waves can not progress to the inner ear and travel through the cochlea before reaching the auditory nerve.

For children with Glue Ear there is nothing wrong with the various parts of the hearing system. The resulting hearing loss or deafness is known as conductive hearing loss.  This means that the sound is not moving through the parts of the ear. Glue Ear can result in a child not being able to hear properly until the sticky fluid in the middle ear goes away. This can take between 6-12 weeks. When there is damage to the parts of the hearing system this is known as sensory-neuro (sense organs and brain).

The other common term for Glue Ear is Otitis Media. This often has other words attached. Acute Otitis Media means that the child has an ear infection, Otitis Media with effusion happens when the ear drum has burst and there is a leakage of fluid and Chronic Otitis Media describes a child who has repeated episodes of fluid in the middle ear. Part of the confusion for parents is that different health care professionals use different terms and there is not always the same explanation given for each term. Despite years of research there are a lot of theories about the causes of Glue Ear, but there is no agreement about why it happens.

Glue Ear Something every parent should know

My name is Carmel Capewell. The aim in writing this blog is to raise the profile of Glue Ear and highlight why it is not a trivial childhood condition.

Some background details:

  • 80% of all children will have at least one episode under the age of 7 years.
  • It is caused by a build-up of fluid in the middle ear which is glue-like (hence the name of the condition). This prevents sound waves travelling through the ear drum so makes sound muffled – like being underwater or having a cold.
  • It may or may not be accompanied by infection. Therefore, anti-biotics are not always needed.
  • Grommets (small ventilation tubes inserted into the ear drum under a general anaesthetic) do not cure Glue Ear. They do relieve the pressure on the ear drum, but can cause scar tissue on it.
  • NICE (i.e. not meaning polite, but clinical guidelines for doctors) say that grommets should be the preferred option for treatment.
  • Parents/carers do not do anything during the Watchful Waiting period of up to 6 months? In most children it resolves itself.
  • There is no agreement about what causes it, how to treat it, or even a definition. Treat anyone who tells you they know the cause, with caution – it is a bit like the common cold, lots of theories but not agreed cause.
  • Grommets and Glue Ear are not the same.
  • There are no support groups (anywhere in the world, and I have looked).

I am writing this blog and, intend to do so regularly, because many parents feel isolated and do not really know how to support their child. I think this is because Glue Ear is said to be trivial and temporary which goes back to the last point in the list above. Because the hearing loss is temporary and intermittent then the child is often labelled as naughty, stubborn or defiant.

Many GPs will not refer children on to Ear, Nose and Throat (ENT) consultants. They may dismiss concerns about the recurring ear infections/loss of hearing. They do not receive training in it. However, it is the most common reason for a child visiting their doctor or having surgery.

Despite it being so common it is not included in initial training for teachers or early years practitioners. Teachers often make that mistake of seeing glue ear and grommets as the same thing. Alternatively, they see grommets as a cure.  I strongly believe that needs changing.

If you do a Google (or any other search engine) search (try it now), there will be lots of information about the medical description of Glue Ear and grommet surgery, but little practical information about how to support a child with it or what it is like to experience it.

Internet forums on Glue Ear are not monitored by professionals who can offer advice based on research and good practice. Questions often go unanswered or receive a response from parents in a similar situation.

My own experience as an aunt and parent of children who have the condition into adulthood prompted me to do a PhD in the subject. Through this blog, I intend to provide information and support for families and individuals impacted by the chronic condition of Glue Ear. I am happy to be contacted and look forward to positive and helpful exchanges. I welcome suggestions for further updates.