Grommets and glue ear
At age 3, only 20% of children with PCD. have normal hearing, by 6, this is around 60% and by early teens, nearly all are normal.
If I have glue ear will grommets work?
A question frequently asked by parents is whether or not grommets should be used in the treatment of glue ear in children with PCD. Unfortunately this cannot be answered with a simple yes or no, says Mr. Ian Mackay who is the consultant ENT surgeon at the Royal Brompton and Charing Cross Hospitals.
Children, regardless of whether they have PCD are prone to glue ear which results in a variable hearing loss. This condition will often resolve spontaneously but if it does not, the normal management would be to make a small hole in the eardrum (myringotomy) under general anaesthesia and to insert a very small plastic tube or grommet. This is shaped rather like a cotton reel and is used to keep the hole open, but usually, after a year or so, this will extrude and the hole should close spontaneously.
Patients with PCD will invariably have a degree of serous fluid in the middle ear as the cilia, which normally move the mucus from the middle ear to the back of the nose, are not beating. This usually results in a mild hearing loss of some 10-20 dB. Unlike glue ear in other children, this condition will persist despite any treatment; inserting grommets will often result in the ear simply discharging and there will be little noticeable change in hearing. Once a grommet extrudes, the condition will inevitably recur.
Generally therefore the insertion of grommets for these children whose symptoms are minimal is not advocated although, of course, there are going to be exceptions. If the condition deteriorates to the point where the hearing loss is more severe (35-40 dB or more), there may be an indication of undertaking surgery. As the ears often discharge following surgery, insertion of a grommet is sometimes advocated in one ear only leaving the other ear free to be aided with a hearing aid if necessary.
In conclusion, there should be no rush into having grommets inserted simply because there is fluid in the middle ear as this is likely to persist despite treatment and more importantly is not really necessary. If however the hearing loss becomes significant, and the condition fails to improve in 3-6 months, then surgery may be indicated.