Grommet Insertion: Common Questions Answered

Medically reviewed by: This article has been medically reviewed by Mr Ravinder Natt, BSc (Immunology) MBBS MRCS DO-HNS FRCS (ORL-HNS), Consultant ENT, Head and Neck Surgeon at St John & St Elizabeth Hospital.

Grommet insertion is a short operation to place a tiny plastic tube into a child’s eardrum, allowing air to reach the middle ear and any fluid to drain away rather than building up behind it. It’s most often recommended for children with glue ear or recurrent ear infections that haven’t cleared up on their own.

If your child has been referred for grommets, it’s natural to feel some anxiety and have questions: what the procedure actually involves, what to expect on the day, and how to look after your child afterwards. This article answers the questions parents ask us most.

What Are Grommets and Why Are They Used?

Grommets, sometimes called ear tubes, are tiny plastic tubes, about the size of a grain of rice, inserted through a small hole in the eardrum, also known as the tympanic membrane. Their job is to keep air moving in and out of the middle ear, equalising pressure and reducing fluid build-up, rather than allowing it to collect behind the eardrum.

Grommets are one of the most effective glue ear treatments available. Glue ear happens when sticky fluid builds up in the middle ear, often after a cold, and can cause muffled hearing and, if it persists, occasionally affects speech development in young children. When symptoms don’t improve after a period of monitoring, or a child has recurrent ear infections, an ENT surgeon may recommend inserting grommets as the next step. We cover glue ear in more detail in our guide to common ENT conditions in children.

The Grommet Insertion Procedure

Grommet insertion is a small operation, usually carried out as day case surgery, meaning your child goes home the same day. In most children, it’s performed under general anaesthesia, so your child is asleep and feels nothing during the procedure. In some older children, it may be possible to use a local anaesthetic instead.

Using an operating microscope, the surgeon makes a very small hole in the eardrum. Any fluid present in the middle ear is removed using a fine sucker, sometimes described as gentle suction, and a small plastic tube, the grommet, is then inserted into the hole. Once the grommets are inserted, the ear is checked before your child wakes up. The whole grommet insertion procedure typically takes around 15 to 20 minutes, and most children go home a few hours later, once they’ve recovered from the anaesthesia.

What to Expect on the Day

Knowing roughly how the day will unfold can make it much less daunting for both you and your child. While your surgical team will give you exact timings and instructions in advance, most children’s grommet insertion follows a similar pattern:

1. Arrival and check-in. You’ll arrive at your allotted time and be checked in by the paediatric nursing team, who’ll show you to a ward or waiting area designed with children in mind.
2. Pre-op checks. A nurse and the anaesthetist will see your child to confirm details, answer any last questions, and go over the fasting instructions you’ll have been given ahead of the appointment.
3. Meeting the surgeon. Your ENT surgeon will see you before the operation to confirm the plan and check whether you or your child have any final questions.
4. Going to theatre. Your child is taken through to theatre, usually with a parent able to stay until they’re asleep under the general anaesthesia, before you’re shown to a nearby waiting area.
5. The procedure. Grommet insertion itself typically takes around 15 to 20 minutes, as described above.
6. Recovery room. Your child wakes up in a recovery area under close nursing supervision, and you’ll be brought back together as soon as they’re settled.
7. Going home. Once your child has recovered from the anaesthetic and is eating and drinking normally, you’ll be given aftercare advice and can take them home, usually within a few hours of the operation.

Recovery and Aftercare following Grommet Insertion

Most children recover quickly after grommet insertion, and many notice an improvement in their hearing within a few days, once the trapped fluid has been able to drain away. Mild earache or discomfort in the first day or two is normal and can usually be managed with age-appropriate paracetamol or ibuprofen, using the doses recommended on the packet or by your pharmacist.

Your child can usually return to normal activities, including nursery or school, within a day or two, though it’s sensible to avoid swimming pools for the first couple of weeks while the ear settles.

Swimming with grommets: Many parents ask whether their child can go swimming with grommets in place. In general, ordinary swimming is fine once your child has recovered from the operation, though it’s best to avoid diving or submerging the head, and to keep soapy water out of the ear during baths, since this can increase the risk of infection. Some surgeons recommend earplugs for swimming, particularly in pools with high chlorine content or in open water; ask your surgeon for guidance specific to your child.

Follow-up: Your surgeon will usually see your child for a follow-up appointment around six weeks after the operation, to check how the ear is healing and confirm the grommets are working well.

Signs to watch for: A small amount of discharge from the ear in the days after surgery is common and not usually a cause for concern. However, contact your surgeon or GP if you notice persistent discharge, worsening pain, or a temperature, as these can be signs of infection.

How Long Do Grommets Last?

Grommets are designed to fall out on their own as the eardrum grows and heals, typically within 6 to 12 months, though this varies from child to child. As the tube is gradually pushed out, the small hole in the eardrum heals over, usually without any lasting effect on hearing, which typically returns to normal once the fluid has cleared.

In most cases, grommets don’t need to be removed. They simply fall out and pass unnoticed, sometimes in earwax or during a bath. Occasionally, a grommet needs to be removed by a surgeon if it doesn’t fall out naturally once it’s no longer needed. If a grommet stays in place for much longer than expected, or your child’s symptoms return after a previous set has fallen out, your

ENT surgeon can advise on the best next step. A small number of children need grommets again if glue ear or ear infections return.

Risks and Complications of Grommet Insertion

Grommet insertion is a common operation and generally safe, but as with any surgery, there are some risks to be aware of. Complications are uncommon but can occur. The most common complication is a minor ear infection with discharge, which can usually be treated with antibiotic ear drops. Less commonly, a small hole may remain in the tympanic membrane after the grommet falls out, which may need a minor repair procedure if it doesn’t heal on its own. Occasionally, a small area of scarring or thickening on the eardrum, known as tympanosclerosis, can remain after a grommet falls out or is removed; this is usually harmless and doesn’t normally affect hearing.
Serious complications are rare. Your surgeon will talk you through the specific risks present for your child before the operation, and answer any questions you or your child may have.

Frequently Asked Questions About Grommets

Do grommets fall out on their own?
Yes. Grommets are designed to fall out naturally as the eardrum heals and grows, usually within 6 to 12 months. You may not notice when this happens, as the grommet is tiny and often comes out in earwax or during bathing.

Will my child need grommets again?
Most children only need one set of grommets. However, if glue ear or recurrent ear infections return after the grommets have fallen out, a small number of children go on to need a second set.

What can you not do with grommets?
There aren’t many hard restrictions, which surprises a lot of parents. The main ones are: avoid diving, jumping in, or submerging the head underwater while swimming, since this can push water into the ear canal; keep soapy or shampoo-heavy water out of the ears during baths, as this can irritate the middle ear; and avoid inserting anything into the ear canal, including cotton buds. Ordinary swimming, baths, and everyday play are otherwise fine once your child has recovered from the operation. Flying isn’t usually a problem either; grommets equalise pressure, so some children actually find flying more comfortable with grommets in than without.

What are the pros and cons of grommets?

Pros:

• Quick, routine day-case procedure, usually 15 to 20 minutes, with most children home the same day
• Many children notice an improvement in hearing within days, once trapped fluid can drain away
• Reduces the frequency of ear infections in children who were getting them repeatedly
• Low complication rate overall, and most issues that do occur are minor and treatable
• No ongoing daily care needed once healed; the grommet simply sits in place

Cons:

• Requires a general anaesthetic in most children, which carries its own (small) risks
• Some minor discomfort, discharge, or risk of infection in the days after surgery
• Swimming precautions needed for a couple of weeks while the ear settles
• Doesn’t treat the underlying cause of glue ear, so if the cause (often colds, allergies, or enlarged adenoids) persists, symptoms can return and a second set may be needed