Children with uncomplicated grommet insertion are usually followed up in the paediatric audiology department with a hearing test and audiology led otoscopy approximately 2-3 months post operatively. Should this highlight any problems, the child will be referred back to ENT by the Paediatric Audiology team.
Usually children can go back to swimming without water precautions after this appointment. Some surgeons recommend water precautions in the form of ear plugs and head band for up to 12 months post operatively.
New recommendations are about to be published and will most likely include advice on water proofing for one month only.
Grommets usually remain within the tympanic membrane for 6-24 months. The membrane then heals over after extrusion. Grommets in the ear canal are normal and no cause for concern. They do not need to be removed.
The most common post-operative complication is otorrhoea, which can be successfully treated with ear drops.
Ciprofloxacin/dexamethasone combination ear drops,4 drops bd for 7 days have recently been licensed for this purpose.
Children might need further review in primary care to ensure grommets have extruded if parents want to defer swimming until this is the case.
Who to refer:
- Ongoing otorrhoea after grommet insertion or after extrusion that does not settle with primary care management
- Non-healing perforation (usually heals within 3 months)
- Recurrence of hearing loss/RAOM after grommet extrusion and healing of tympanic membrane.
Post-grommet otorrhoea: non ototoxic topical ear drops (Ciprofloxacin, alone, or in combination with dexamethasone)
If parents concerned about swimming, check periodically if grommets have extruded.
