Dr Paul Leuschner
Ear, Nose, and Throat (ENT) Specialist
Suite 105 B, Mediclinic Kloof, 511 Jochemus Street, Erasmuskloof, 0048
T: 012 367 4422
To be able to answer this question we must first understand the anatomical difference between the ear structure of children and adults.
The middle ear is connected to the back of the nose via the Eustachian tube. This tube equalizes the pressure in the middle ear and drains the fluid from the middle ear to the back of the nose. This tube in adults runs at a 45˚ angle and in children only at a 10˚ angle. The angle of the tube increases as the child grows and is mature at around seven or eight years of age. This is the main reason children are more likely to get middle ear infections.
A grommet or ventilation tube is a tube that is placed in the eardrum to allow the middle ear to equalize and drain through the grommet instead of the non-functional Eustachian tube. This is usually a temporary solution until the Eustachian tube can take over its normal function again.
The grommets have varied sizes and are made of different materials. The choice of the grommet will be made on the duration the grommet needs to stay in. The tubes usually fall out in time, and the Eustachian tube should then be able to take over its normal function again.
When do we consider putting in grommets?
- Acute infection that does not resolve on medical treatment – usually painful ears.
- Mastoiditis – infection that involves the bone behind the ear – usually painful ears.
- Persistent effusion in the middle ear despite medical treatment – usually not painful.
- Retraction of the eardrum – usually not painful.
- Patients with cleft palates – their Eustachian tubes are more likely to be dysfunctional.
Any of the abovementioned conditions will most probable cause a conductive hearing loss due to the immobility of the eardrum. If the hearing nerves are normal, one should be able to correct the conductive hearing loss by inserting a grommet. It is therefor important to seek medical advice if you are not sure about your child’s hearing.
