Children with a cleft lip and palate nearly always have problems with fluid build-up in the middle ear. The middle ear is the space behind the eardrum, in which the auditory ossicles need to be able to move freely. If there is fluid in this space the movement is reduced, which results in hearing loss. Hearing loss at a young age must be avoided because it leads to a delay in speech and language development. Long-term fluid build-up also results in retraction of the eardrum and possible damage to the auditory ossicles.
The tube that drains the fluid that builds up in the middle ear (the Eustachian tube) is normally opened by the muscles of the palate each time when swallowing. If the palate has a cleft, the palate muscles are no longer joined together in the midline and these muscles cannot open the Eustachian tube efficiently each time when swallowing. This leads to a long-term build-up of fluid in the middle ear.
To prevent the harmful effects of this fluid build-up, it is necessary to provide some help in removing the fluid through this tube. This is done by fitting a small tube across the eardrum (a grommet). This has a similar effect to making a second hole in a milk bottle: the effect is that the fluid can escape more easily through the Eustachian tube, as it is meant to do. This ensures optimum development of hearing, speech and language and optimum health of the ear itself.
This minor operation is done for the first time at the same time as surgical closure of the soft palate, at about 12 months of age. A grommet normally stays in place for 6 to 18 months and usually grows out of the eardrum leaving no injury behind. It usually has to be reinserted when the child is 5 years old.
Your child can swim with a grommet, but should not dive into deep water, which is not a problem during the first few years of life when grommets are most necessary. You can use soap and shampoo, but you should avoid getting them in your child's ears.