Eardrum tubes (grommets) for children

Information booklet on having grommets placed in your child’s ears

Your child is expected on ………….day, ……-…….- 20… at …… hours in the waiting room of the Outpatients’ Operating theatre (POK) on the 3rd floor.

In consultation with your ear, nose and throat specialist (ENT specialist), it has been decided to place tympanostomy tubes (grommets) in your child’s ears. In medical terms, this is an easy operation but an operation like this is no small matter for a child. Therefore, it is important that you prepare your child well as possible by telling him or her what is going to happen. If you do so, your child will probably experience the operation as less unpleasant and will be better equipped to deal with it.

To prepare your child well, it is important that you yourself are well-informed about the procedure. That is what this booklet is about. Should you still have any questions after reading it, please do not hesitate to contact your ENT specialist.

What are grommets?
Grommets are very small tubes that are inserted into the eardrums (tympanic membranes). On the picture below, you can see how this tube is placed in the eardrum. These tubes are meant to create an open connection between the middle ear and the external auditory duct, thus allowing air to enter the middle ear through the tube.

A: External auditory duct. B: Tympanostomy tube/grommets. C: Middle Ear. D: Ossicles. E: Eustachian tube.

Preparations by the anaesthesiologist
During the consultation at the Preoperative Outpatients’ Clinic, the anaesthesiologist will inform you about anaesthesia and pain control (please see below). Your child’s lungs and heart will also be examined. If you wish, your child can also try out the anaesthesia mask and the balloon in a play situation.

Preparations at home
The way in which you prepare your child at home, depends on your child’s age and character. It is better not to inform toddlers and infants too long in advance. Often, they have no sense of time. One or two days before the operation seems reasonable.

If your child is a little older, you are free to determine the right moment for yourself. Some children prefer to know what is going to happen to them.

Other children use their imagination and get unnecessarily anxious when they are informed too long in advance. Your child should, however, have the opportunity to absorb the matter and, if neccessary, to ask some questions. It will be easier to prepare your child, if you can promise him or her that you will stay there until he/she falls asleep and you will also be present when he/she wakes up. This means that you can answer your child’s questions immediately.

For a smooth and successful operation, you must adhere to a number of rules:   No food and limited fluids
Because of the anaesthesia, it is very important that your child has an empty stomach. Therefore, on the evening of the operation, your child may not eat anything after midnight. On the morning of the operation, your child should also not brush his/her teeth.

Until two hours before the agreed time of operation, your child is allowed to drink clear liquids, such as:

• water;
• tea without milk;
• lemonade made of water and a small amount of syrup;
• apple juice.

No aspirin
For as long as two weeks before the operation, your child is not allowed to take any medication containing aspirin (Aspro, Dolviran, APC, Chefarine etc.). Aspirin increases the risk of haemorrhaging during and after the operation.

Medication
If your child takes medication, please discuss this in advance with your ENT specialist, so the latter can judge whether this should be taken into account. 

Transport back home
Please arrange transport back home by car but do not drive yourself. Your child may get nauseous on the way. Therefore, we advise you to bring a towel with you.

Illnesses
If your child is ill, we will not proceed with the operation. This is also the case if, in the immediate vicinity of your child, there are infectious diseases such as: measles, whooping cough, German measles (Rubella), mumps or scarlet fever. In case of any doubt, please do not hesitate to contact us: Tel: 070 - 312 44 08 / 070 - 312 44 20.

What should you bring?

• Your hospital registration card.
• Any medication your child has to take.
• A cuddly toy, a doll, a book, and some toys for the waiting room.

Procedure on the day of the operation
On the day of the operation, please go to the waiting room of the Outpatients’ Operating theatre (POK) on the 3rd floor. You and your child will be collected and brought to the surgery’s waiting room. There, your child will be given a drink in preparation for the operation. This will make your child quiet and relaxed. This medicine will start to work in about 30 to 60 minutes. Please stay with your child the whole time.  

Your child will be given a wristband with his/her name on it. In about half an hour, your child will be collected and brought to the operating theatre, together with you (i.e. with one of the parents). The medical team will be waiting in surgical scrubs. The anaesthesiologist will put the mask on your child’s face and ask him or her to blow in it. In about one or two minutes, your child will fall asleep. Sometimes, children will roll their eyes a little or wave their arms and legs. As soon as your child is asleep, you will be requested to leave the operating room.  

The entire operation will only take a few minutes. After that, your child will be brought back to you. A nurse will always be present in the recovery room. Most children will cry when they wake up. Sometimes, a little blood or fluid will ooze out of the ear. Shortly after the operation, as soon as your child is fully awake, you can take him/her home.

Back home
When you are back at home, please give your child something to drink. If your child is not nauseous from the anaesthesia, he/she may eat and drink anything. The day after the operation, your child can go to school again. One week after the operation, your child is allowed to swim without precautionary measures. No special precautions are needed if your child takes a shower or bath.

Letting off steam
It is possible that your child still needs to work off some bottled-up tensions. Therefore, he/she may be a little difficult during the first days. However, if your child is properly looked after, this will usually go away by itself. It may help to give your child a little extra attention during the first days. Your child simply needs a little extra affection and patience. A bit of spoiling cannot hurt.

When to send for a doctor?
Please contact the hospital if, after two days, there is still some fluid oozing out of the ear. During daytime, you can call the ENT Outpatients’ Department on tel.: 070 - 312 44 08. During evenings, nights, and weekends, you can call the Accident and Emergency Department (Spoedeisende hulp) on tel. 312 44 45.

Check-up
Six weeks after the operation, you and your child are expected at the ENT Outpatients’ Department for a check-up. You will be given an appointment card for this when you leave the hospital. Often, we will then perform a hearing test (for children under the age of 4, an automatic otoacoustic emissions test (“OAE”), and for children of 4 years and older, a regular hearing test).

Finally
Should you have any questions after reading this booklet, please do not hesitate to contact the ENT Outpatients’ Department. The Outpatients’ Department can be reached during office hours on tel. 070 - 312 44 08.

We value your opinion. If you have any comments or suggestions with respect to this booklet or the treatment, please let us know.

Additional information

Right to information and consent
Every child has the right to be fully informed about a course of treatment or medical procedure. This has been laid down in the Dutch Medical Treatment Contracts Act (Wet op de Geneeskunde Behandelingsovereenkomst). In this respect, a child’s rights are no different from those of an adult. However, the aspect of granting consent is different. In very general terms, the statutory regulations on giving consent to treat a child are as follows.

Children up to twelve years of age
In the case of children below twelve years of age, consent must be given by the child’s legal representative (usually the parents).

Children between twelve and sixteen years of age
The decision about treating a child of between twelve and sixteen years old is made jointly by the parents and the child. This means that both the child and the parents must give consent.

Children of sixteen years of age and older
The Dutch Medical Treatment Contracts Act considers children over the age of sixteen to be adults, and capable of making their own decisions about treatment. All information is aimed directly at the young person concerned, and the parents or guardians will only be involved in decisions if he/she agrees.

Treatment may not be given without the express consent of a patient or his/her legal representative. Exceptions to this rule include: acute situations or situations in which failure to treat could endanger the child.

National Child and Hospital Association
In April 2008, the National Child and Hospital Association [Landelijke Vereniging Kind en Ziekenhuis] awarded Bronovo a Smiley for its children’s department. This national association is responsible for awarding Smiley quality marks to hospitals with outstanding facilities for children and parents.The National Child and Hospital Association aims to help parents by: boosting children’s wellbeing before, during and after being admitted to hospital. The Association publishes various leaflets and runs a useful website.

National Child and Hospital Association
Korte Kalkhaven 9
3311 JM Dordrecht

Tel +31 (0)78-614 63 61

www.kindenziekenhuis.nl (only in Dutch)    

Edition: May 2010/80