How much does grommet surgery cost? We're all ears

So, what does grommet surgery involve? How much will the procedure cost? And will your private health insurance cover it?

What are grommets?

Grommets are very small drainage tubes used to treat chronic ear infections or ‘glue ear’, which is a build up of fluid in the inner ear that can result from repeated ear infections, according to the Australian Society of Otolaryngology, Head and Neck Surgery (ASOHNS). Often referred to as ventilation tubes, grommets are placed into the eardrum, allowing air to flow through to the middle ear and any fluid to drain out of it.

According to the President of ASOHNS, Philip Fisher, there are a couple of types of grommets available in Australia, with short-term grommets lasting nine to 12 months, medium-term grommets lasting two to four years and long-term grommets lasting between five and 15 years.

Grommet surgery, which takes between 20 to 30 minutes, involves making a hole in the eardrum and inserting the grommet. The ear drum then heals around the grommet, holding it in position. The surgery can be carried out under local or general anaesthetic, but general anaesthetic is more commonly used with children, Dr Fisher told Canstar.

“In some cases, if an adult has the appropriate ear anatomy to allow access to the ear drum, the procedure can be done under local anaesthetic in the office,” he said.

Most patients can go home as soon as they’ve recovered from the anaesthetic, according to Dr Fisher. Recovery post-surgery is also quick, with most children able to return to school the following day. If adenoids are removed at the same time, Dr Fisher says recovery can be slower, taking up to a week.

How much does grommet surgery cost?

The cost of grommet surgery can vary depending on whether you opt to go through the public or private system. Treatment via the public health system is typically free of charge (thanks to rebates from Medicare), however there may be a waiting time depending on demand at your local hospital. Grommet surgery is generally classed as a ‘Category 3’ elective (non-urgent) procedure with waiting times estimated at up to 12 months. However, a patient could wait up to four years from the time of referral until the time of treatment in some instances, according to Dr Fisher.

If you opt to go through the private system, the out-of-pocket costs you face will depend on the individual fees charged by the hospital and health professionals. This could include a surgeon’s fee, an anaesthetist’s fee and a hospital or theatre fee. The cost of the procedure generally ranges between $800 to $2,000, but some health funds estimate over $3,000. However, a Medicare rebate does apply for the surgery, with the current fee in the Medicare Benefits Schedule (MBS) set at $242.60 for a grommet in the first ear, and half of this ($121.30) for a grommet in the second ear, according to Dr Fisher. Medicare pays 75-85% of this fee.

Best #InformedConsent . 9 yo patient drew me their #grommet #surgery Thanks Kaelin??@RACSurgeons pic.twitter.com/Cx5eEsy3Lh

— Kelvin Kong (@KelvinKongENT) October 31, 2019

The remainder may be covered by your health insurance, depending on your cover. It could be worthwhile checking your product disclosure statement (PDS) or contacting your insurer to find out if you are covered. Keep in mind, you may need to pay an excess when making a claim with your health insurer, the amount of which will be specified in your PDS.

According to Dr Fisher, a follow-up appointment with your specialist is often required four to six weeks after the surgery. Further follow-up appointments are also required until the grommets fall out – as they are designed to do – which usually takes between six and 12 months. In some more extreme cases, children can require follow ups with a specialist for several years, says Dr Fisher, which will again impact the overall cost.

Do you need grommets?

There are a number of reasons why a doctor might recommend grommet surgery for you or your child, including if you’ve had three or more ear infections within a six-month period, or if glue ear has lasted for more than three months. Grommets may also be required in cases where there has been hearing loss or eardrum damage.

While adults and children can both require grommet surgery, the procedure is more common in children due to their “immature” eustachian tubes – the draining tubes that run from the middle ear to the back of the nose, Dr Fisher said. Problems with these tubes can lead to fluid build-up in the ear, which can potentially cause hearing loss.

Grommet surgery can also be conducted in adults who have poor eustachian tube function, and those who have trouble equalising the air pressure in their ears when flying. Symptoms can include feeling like your ears are blocked, moderate to severe pain in your ear, and muffled hearing or moderate hearing loss.

According to Dr Fisher, if left untreated, ear issues can cause significant developmental delays for children, such as delayed speech (which can create educational and social problems), and in some cases, loss of balance – particularly with very young children.

Is grommet surgery covered by private health insurance?

According to Canstar Research, most private hospital policies on our database include cover for ear, nose and throat procedures, including the insertion and removal (if required) of grommets. This applies to policies from the Bronze category and up. If you have a Basic or Basic Plus policy, check your PDS to see if you are covered.

Given the potential complexity of the procedure with individual fees from the surgeon, anaesthetist and hospital, Dr Fisher recommends confirming with your insurer what your out-of-pocket costs will be prior to undergoing the surgery. Your out-of-pocket expenses will also depend on the type of cover you have.

When budgeting, keep in mind your private health cover may have an excess, which in some cases can be up to $1,500 per claim, depending on your circumstances. It’s also worth noting the waiting period that may apply from when you take out the cover and when you can make a claim for grommet surgery, with some policies having a two-month waiting period, or a 12-month waiting period if it relates to a pre-existing condition. A waiting period may also apply at your chosen private hospital, due to demand.

If you require grommet surgery for yourself or your child, it may be worth investigating both private and public options to see what will suit you best, considering the differences in waiting periods and out-of-pocket costs for both.

About Ali Hiddlestone

Ali is a freelance writer covering everything from finance, health, lifestyle, travel, media and real estate. Her articles have featured in several publications including Coast Beat magazine and Huffington Post. Prior to working freelance, Ali worked extensively in TV and print media, marketing, PR and Advertising in Australia and overseas.

Main image source: Master1305 (Shutterstock)