Grommets

Otitis Media – inflammation of the middle ear is a common childhood affliction the world over.  Every year there are about 1.5 million cases in the UK and 2.2.million cases in the US.  It is caused by a bacterial or viral infection spreading to the ear from the nose, throat, and sinuses, symptoms to include ear pain, redness and swelling with bulging of the ear drum.  There may also be a discharge (effusion) in the later stages when the accumulate of pus causes the eardrum to burst.

Unchecked OM can become a chronic condition;  when the discharge is sticky and persistent it is known as ‘glue-ear’.  If the condition does not clear up the build up of fluid can cause hearing loss by blocking the tubes to the ears and by preventing the vibration of the bones that conduct sound in the middle ear.   Over time, this can affect the child’s speech and behavioural development.

The thick catarrh can also act as a breeding ground for bacteria and fungi, making the child prone to reinfection.  Inserting grommets restores hearing by allowing air back into the middle ear.  It also relieves the symptoms by equalising the pressure between the middle ear and the outside.  However many doctors use surgery alone to manage OM, a function for which it repeatedly fails.  Four years after a 1992 UK government leaflet alerting doctors to the ineffectiveness of the procedure was published, an estimated 90,000 grommets insertions were avoided (BMJ,2001;323:1096-7)

Antibiotics were the first port of call for many doctors in the past, but are prescribed less frequently as more resistant strains of bacteria emerge.  Disturbingly, however the US seems to be advocating a heavier reliance on grommet surgery as antibiotics became less effective.  One study suggests surgery for OM, along with adenoidectomy in preference to repeated treatments with antibiotics.

HOW IS THE OPERATION PERFORMED?

The child is put under a general anaesthetic and the grommet (a tiny plastic tube) is placed into a small nick made in the eardrum. The operation takes about 10-15 minutes and the child is allowed to go home after an hour or two. The tubes stay in place for 6-15 months,depending on the type of tube and the child.

IS THE OPERATION SAFE?

This is a relatively safe procedure, involving the usual complications of general anaesthesia and a small risk of permanent hearing loss (0.7  per cent)

Risk of eardrum perforation (about 2-3 percent) or damage to the eardrum.

Displacement of the grommet into the middle ear.

The purpose of grommets is to drain the middle ear allowing air to enter,  thus equalising the pressure between the middle ear and the outside; reduce pain and restore hearing.  Grommets do not control bacterial/viral infection- apart from helping to disperse sticky catarrh that might otherwise cause reinfection and are only effective for as long as they remain in the ear.

The eustachian tubes in an infant are angled differently, so fluid may tend to collect in the ear.  Given time and no intervention, the ear will develop normally and clear the fluid by itself.

Around 80% per cent of cases of glue ear heal spontaneously within a year if left alone(HNO, 1987;35:55-60)

Persistent glue ear may be caused by allergies which can affect mucocilary  function in the eustachian tube, causing obstruction leading to underventilation of the middle ear and the effusion of fluid.

Other studies have also found a significant link between food allergy and serious recurrent ear infections.  When these allergic children were put on food elimination diets their condition improved significantly in 86 per cent of cases, Wheat, and all milk products were in particularly the worst offenders.

NATURAL APPROACHES

Breast feed your child for as long as possible.

Consider keeping your child at home during the pre-school years.  Studies have shown that children in child care outside the home – whether it is for four or 40 hours a week have a 50 per cent greater chance of repeated ear infections than those cared for at home, especially after one bout of infections.  If this is not practical, then consider keeping your child at home during the first three months after an acute attack, as this will considerably reduce the risk of OM becoming a chronic condition.

Make sure your child drinks plenty of water, approximately one pint per foot of height per day. Dehydration worsens glue ear by allowing the mucus to become thicker.

Stop smoking and keep your child away from smoky environments.

Try essential oils.  Chamomile and lavender oils massaged into the ear around the ear may help ease the pain in the early stages.  Lavender oil inhalations may help open up he eustachian tube and allow the catarrh to drain.

Try homoeopathy. Remedies such as Silica and Belladonna can be effective for ear infectoins while Allium sativa can ease the catarrh associated with glue ear.