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1. Preparation

WHAT ARE GROMMETS?

Grommets are tiny plastic ventilation tubes that are flanged at the end. They are inserted into the eardrum, to equalise pressure in the ear.


Some children may need their grommets replaced as they are naturally expelled with the growth of the eardrum.


grommets.gif

WHY IS IT DONE?

Either acute middle ear infection called otitis media or a blockage of the Eustachian tube known as glue ear are the most common reasons that insertion of grommets is required. In the majority of cases, these conditions affect children but adults can also be affected.


Otitis Media – This is an ear infection with the following symptoms:


  • Earache
  • Deafness
  • Fever
  • Feeling of fullness in the ear
  • Drainage of blood or pus
  • Feeling unwell
  • Loss of appetite
  • Irritability
  • Loss of balance

Because grommets allow air in from the outside, enabling fluid and mucus to drain normally, future episodes of acute otitis media are reduced as well as an immediate improvement in hearing. Parents of children afflicted with this condition notice an improvement in balance, ability to walk, disposition and sleeping.


Glue ear – Is a chronic ear infection.


A sticky fluid gathers inside the middle ear. Because the middle ear is normally filled with air instead of fluid, hearing can be affected when you have glue ear.


HOW DO I CHOOSE A SPECIALIST?

Your GP, or the doctor you first consulted, will be able to recommend and refer your to an ENT surgeon who can perform the procedure.


You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. These are often good organisations to turn to for information about what you can expect from your medical specialist. You can access the Royal Australian College of Surgeons via their website: www.surgeons.org


The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).


To access a list of ENT surgeons who participate in HCF’s Medicover no gap arrangement:


Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment. Some doctors who participate in the HCF medicover no gap arrangement have chosen not to be listed on the HCF website. Therefore you will need to check with your doctor.


WHAT SHOULD I ASK MY SPECIALIST?

  • Make sure you fully understand the procedure that is planned; do not be afraid to ask.
  • It is your right to know all the relevant information, as this is part of informed clinical consent. Your doctor will ask you to sign a consent form.
  • Apart from what the procedure is about you should also ask about:
  • Preparation
  • Follow up appointments - jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
  • Most medication should be continued as usual, but some may interfere with the examination. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
  • Aspirin (or any related products),
  • Blood thinners (Warfarin, heparin.),
  • Arthritis medication,
  • Pain medication,
  • Insulin, and iron preparations
Don’t forget to mention any homeopathic or herbal remedies you are taking, as these can have interactions and side effects too.

WHERE IS IT DONE?

The insertion of grommets is done as a day patient in either a day surgery or hospital.


HOW LONG IS THE PROCEDURE?

The insertion of a grommet takes approximately 10 -15 minutes.


WHO IS INVOLVED?

The procedure is usually carried out as a day surgery patient in a specialised day surgery or hospital. The people involved in the procedure are:


  • The ENT (Ear, Nose & Throat) surgeon, your doctor (Specialist),
  • Anaesthetist: they give medication that make you relaxed and sleepy and look after you whilst the procedure is being carried out
  • Nurses for the procedure and recovery

HOW DO I PREPARE FOR THE SURGERY?

You are normally required to fast for at least 6 hours prior to general anaesthetic.


Young children and babies are required to fast from clear fluids for 2 hours, other fluids for 3 or 4 hours and approximately 5 hours for solids. Surgery for young children and babies is scheduled first to lesson the discomfort of fasting.


Your surgeon will have his/her own specific preparation requirements and those, along with any instructions given to you by the day surgery or hospital, should be strictly followed.


WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?

  • Do not bring any valuables with you
  • Leave all jewellery at home, except if you wear a wedding ring
  • Bring any medication that you would usually take during the day as under most circumstances you may still be able to take these
  • Remove all nail polish and do not wear any make-up
  • Any specific requirements your child may need, for example, formula and nappies

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims paid for Insertion of Grommets admissions for the financial year 13/14 are provided below:

On Average

Charge Medicare Pays HCF Pays 3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation, theatre and hospital related services) $1,199 $0 $1,200
1 Medical Services Component
Anaesthetics $451 $151 $144 $316 49.2% $0 50.8%
Ear, Nose & Throat Surgical Services $822 $273 $285 $625 42.0% $0 58.0%
2 Total Average Medical Services $1,171 $390 $395 $679 56.7% $0 43.3%
Hospital and Medical Services Average for Insertion of Grommets Admissions $2,370 $390 $1,595 $679 56.7% $0 5 43.3%

grommets_14.gif

Points to Note:

  • Charges are based on HCF claims for a sample size of 2,240 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 41632.

  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).

1 These medical services are in-patient services only.

2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here e.g. pathology services. Therefore, the total average medical service charge ($1,171) differs from the sum of the individual average charges as shown.

3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

5 This percentage indicates the total coverage of hospital and medical services for all insertion of grommets admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.

2. Day of procedure

WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?

When you arrive at the day surgery or hospital, the admissions clerk will attend to the associated paperwork for your stay.


On admission the nurse will request your medical history, confirm your medication and ask you about any known allergies. The surgeon has usually already attended to you signing the operation consent form in his rooms at the time of booking the surgery. An anaesthetist may see you at that time or when you are in the procedure room, to explain what to expect with general anaesthetic.


Having completed the admission processes, you/your child will then be taken to theatre.


WHAT CAN I EXPECT DURING SURGERY?

Once in the anaesthetic bay of the operating theatre, a small plastic tube called a cannula will be placed into a vein in the arm or hand. If it is general anaesthetic being given, the cannula is used to administer intravenous sedation, which is the first stage of your anaesthetic.


With children, some anaesthetists may choose to administer a gas anaesthetic via a mask which means your child may not have a cannula inserted. Instead, a face mask is placed over the mouth and your child will fall asleep as they inhale the anaesthetic gas.


To reduce the anxiety for a child having the procedure, a parent may be allowed to stay with and possibly hold the child, until the anaesthetic has taken affect.


Once the anaesthetic has taken effect, you/your child will be moved into the operating theatre and the grommet insertion will begin.


A small incision, approximately 2mm long, will be made in the eardrum and the fluid is drained before inserting the grommet. This lets air into the middle ear. Once the grommet is put into place, ear drops may be put in the ear to minimise any discharge.

You/your child will then be moved to the recovery area.

3. Aftercare

WHAT HAPPENS AFTER SURGERY?

In the recovery room, nursing staff will monitor you/your child’s vital signs such as blood pressure, pulse and temperature until full recovery from the anaesthetic has occurred.


If it is your child that has had the insertion of grommets, you are generally permitted to be in the recovery room beside the bed when your child awakes.


Hearing should be back to normal immediately following the grommet insertion.


You/your child should be able to go home the same day if there are no complications.


You will be given instructions and advice upon discharge to assist you with care once at home. The instructions may include the following:


  • Keep your/your child’s ear/s dry
  • Ear plugs should be worn when swimming
  • Avoid getting shampoo in the ear/s while bathing or showering
  • Do not put anything inside your/your child’s ear to clean it
  • Avoid putting your/your child’s head in the water while in the bath

Generally, there is little or no pain experienced following the surgery but if there is pain, paracetamol or ibuprofen can be used as directed.


You/your child may resume normal activities 24 hours after the grommet insertion.

If any of the following symptoms are experienced, please contact your doctor or the hospital immediately:


  • Ear discharge that is bloody
  • Earache
  • Throbbing in the ear
  • Infection
  • Fever

You/your child will normally be required to attend a review with your specialist 14 days after the procedure. The review includes a hearing test. If there are no complications, a follow-up appointment will occur every six months until the grommet is removed. Once the eardrum heals, the grommet will come out on its own. A small grommet will work its way out in about six months and a larger one takes anywhere from 9-15 months.

1. Preparation

WHAT ARE GROMMETS?

Grommets are tiny plastic ventilation tubes that are flanged at the end. They are inserted into the eardrum, to equalise pressure in the ear.


Some children may need their grommets replaced as they are naturally expelled with the growth of the eardrum.



grommets.gif

WHY IS IT DONE?

Either acute middle ear infection called otitis media or a blockage of the Eustachian tube known as glue ear are the most common reasons that insertion of grommets is required. In the majority of cases, these conditions affect children but adults can also be affected.


Otitis Media – This is an ear infection with the following symptoms:


  • Earache
  • Deafness
  • Fever
  • Feeling of fullness in the ear
  • Drainage of blood or pus
  • Feeling unwell
  • Loss of appetite
  • Irritability
  • Loss of balance

Because grommets allow air in from the outside, enabling fluid and mucus to drain normally, future episodes of acute otitis media are reduced as well as an immediate improvement in hearing. Parents of children afflicted with this condition notice an improvement in balance, ability to walk, disposition and sleeping.


Glue ear – Is a chronic ear infection.


A sticky fluid gathers inside the middle ear. Because the middle ear is normally filled with air instead of fluid, hearing can be affected when you have glue ear.


HOW DO I CHOOSE A SPECIALIST?

Your GP, or the doctor you first consulted, will be able to recommend and refer your to an ENT surgeon who can perform the procedure.


You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. These are often good organisations to turn to for information about what you can expect from your medical specialist. You can access the Royal Australian College of Surgeons via their website: www.surgeons.org


The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).


To access a list of ENT surgeons who participate in HCF’s Medicover no gap arrangement:


Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment. Some doctors who participate in the HCF medicover no gap arrangement have chosen not to be listed on the HCF website. Therefore you will need to check with your doctor.


WHAT SHOULD I ASK MY SPECIALIST?

  • Make sure you fully understand the procedure that is planned; do not be afraid to ask.
  • It is your right to know all the relevant information, as this is part of informed clinical consent. Your doctor will ask you to sign a consent form.
  • Apart from what the procedure is about you should also ask about:
  • Preparation
  • Follow up appointments - jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
  • Most medication should be continued as usual, but some may interfere with the examination. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
  • Aspirin (or any related products),
  • Blood thinners (Warfarin, heparin.),
  • Arthritis medication,
  • Pain medication,
  • Insulin, and iron preparations
Don’t forget to mention any homeopathic or herbal remedies you are taking, as these can have interactions and side effects too.

WHERE IS IT DONE?

The insertion of grommets is done as a day patient in either a day surgery or hospital.


HOW LONG IS THE PROCEDURE?

The insertion of a grommet takes approximately 10 -15 minutes.


WHO IS INVOLVED?

The procedure is usually carried out as a day surgery patient in a specialised day surgery or hospital. The people involved in the procedure are:


  • The ENT (Ear, Nose & Throat) surgeon, your doctor (Specialist),
  • Anaesthetist: they give medication that make you relaxed and sleepy and look after you whilst the procedure is being carried out
  • Nurses for the procedure and recovery

HOW DO I PREPARE FOR THE SURGERY?

You are normally required to fast for at least 6 hours prior to general anaesthetic.


Young children and babies are required to fast from clear fluids for 2 hours, other fluids for 3 or 4 hours and approximately 5 hours for solids. Surgery for young children and babies is scheduled first to lesson the discomfort of fasting.


Your surgeon will have his/her own specific preparation requirements and those, along with any instructions given to you by the day surgery or hospital, should be strictly followed.


WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?

  • Do not bring any valuables with you
  • Leave all jewellery at home, except if you wear a wedding ring
  • Bring any medication that you would usually take during the day as under most circumstances you may still be able to take these
  • Remove all nail polish and do not wear any make-up
  • Any specific requirements your child may need, for example, formula and nappies

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims paid for Insertion of Grommets admissions for the financial year 13/14 are provided below:

On Average

ChargeMedicare PaysHCF Pays3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY% of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY% of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation, theatre and hospital related services)$1,199$0$1,200
1Medical Services Component
Anaesthetics$451$151$144$31649.2%$050.8%
Ear, Nose & Throat Surgical Services$822$273$285$62542.0%$058.0%
2Total Average Medical Services$1,171$390$395$67956.7%$043.3%
Hospital and Medical Services Average for Insertion of Grommets Admissions$2,370$390$1,595$67956.7%$05 43.3%

grommets_14.gif

Points to Note:

  • Charges are based on HCF claims for a sample size of 2,240 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 41632.

  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).

1 These medical services are in-patient services only.

2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here e.g. pathology services. Therefore, the total average medical service charge ($1,171) differs from the sum of the individual average charges as shown.

3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

5 This percentage indicates the total coverage of hospital and medical services for all insertion of grommets admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.


2. Day of procedure

WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?

When you arrive at the day surgery or hospital, the admissions clerk will attend to the associated paperwork for your stay.


On admission the nurse will request your medical history, confirm your medication and ask you about any known allergies. The surgeon has usually already attended to you signing the operation consent form in his rooms at the time of booking the surgery. An anaesthetist may see you at that time or when you are in the procedure room, to explain what to expect with general anaesthetic.


Having completed the admission processes, you/your child will then be taken to theatre.


WHAT CAN I EXPECT DURING SURGERY?

Once in the anaesthetic bay of the operating theatre, a small plastic tube called a cannula will be placed into a vein in the arm or hand. If it is general anaesthetic being given, the cannula is used to administer intravenous sedation, which is the first stage of your anaesthetic.


With children, some anaesthetists may choose to administer a gas anaesthetic via a mask which means your child may not have a cannula inserted. Instead, a face mask is placed over the mouth and your child will fall asleep as they inhale the anaesthetic gas.


To reduce the anxiety for a child having the procedure, a parent may be allowed to stay with and possibly hold the child, until the anaesthetic has taken affect.


Once the anaesthetic has taken effect, you/your child will be moved into the operating theatre and the grommet insertion will begin.


A small incision, approximately 2mm long, will be made in the eardrum and the fluid is drained before inserting the grommet. This lets air into the middle ear. Once the grommet is put into place, ear drops may be put in the ear to minimise any discharge.

You/your child will then be moved to the recovery area.

3. Aftercare

WHAT HAPPENS AFTER SURGERY?

In the recovery room, nursing staff will monitor you/your child’s vital signs such as blood pressure, pulse and temperature until full recovery from the anaesthetic has occurred.


If it is your child that has had the insertion of grommets, you are generally permitted to be in the recovery room beside the bed when your child awakes.


Hearing should be back to normal immediately following the grommet insertion.


You/your child should be able to go home the same day if there are no complications.


You will be given instructions and advice upon discharge to assist you with care once at home. The instructions may include the following:


  • Keep your/your child’s ear/s dry
  • Ear plugs should be worn when swimming
  • Avoid getting shampoo in the ear/s while bathing or showering
  • Do not put anything inside your/your child’s ear to clean it
  • Avoid putting your/your child’s head in the water while in the bath

Generally, there is little or no pain experienced following the surgery but if there is pain, paracetamol or ibuprofen can be used as directed.


You/your child may resume normal activities 24 hours after the grommet insertion.


If any of the following symptoms are experienced, please contact your doctor or the hospital immediately:


  • Ear discharge that is bloody
  • Earache
  • Throbbing in the ear
  • Infection
  • Fever

You/your child will normally be required to attend a review with your specialist 14 days after the procedure. The review includes a hearing test. If there are no complications, a follow-up appointment will occur every six months until the grommet is removed. Once the eardrum heals, the grommet will come out on its own. A small grommet will work its way out in about six months and a larger one takes anywhere from 9-15 months.

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Disclaimer: Information is provided by HCF in good faith for the convenience of members. It is not an endorsement or recommendation of any form of treatment, nor is it a substitute for medical advice, and you should rely on the advice of your treating doctors in relation to all matters concerning your health. Every effort has been taken to ensure the accuracy of this information, however, HCF takes no responsibility for any injury, loss, damage or other consequence of the use of this information.