How much does grommet surgery cost?

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. 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. There are a couple of types of grommets available in Australia. Short-term grommets last for nine to 12 months, medium-term grommets last two to four years and long-term grommets last 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 is more commonly used for children. Most patients can go home as soon as they’ve recovered from the anaesthetic. Recovery post-surgery is also quick, with most children able to return to school the following day. If adenoids (a patch of lymphoid tissue that sits at the very back of the nasal passage) are removed at the same time, 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 list depending on demand at your local hospital. Grommet surgery is generally classed as a ‘Category 3’ elective (non-urgent) procedure with estimated waiting times of up to 12 months. It’s important to keep in mind that once out of hospital, there may be out-of-pocket costs for things like medication and/or relevant allied health services.

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 surgeon’s, anaesthetist’s and hospital or theatre fees. The cost of grommet surgery is generally around $2,800 (which includes specialist and hospital fees), with an estimated patient out of pocket cost of $500. This includes a Medicare rebate, with the current fee in the Medicare Benefits Schedule (MBS) set at $272.05 for a grommet in the first ear, and half of this ($136.05) for a grommet in the second. Medicare generally pays 75-85% of this fee.

The remainder may be covered by your health insurance, depending on your cover. It could be worthwhile checking your Private Health Information Statement (PHIS) or contacting your insurer to find out if you’re 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 PHIS. If you’re interested in comparing policies with hospital cover, you can do so using Canstar’s comparison tables.

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 an extended period of time (up to several years), 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. 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. 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.

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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. This may include the insertion and removal (if required) of grommets, but this type of procedure is usually a part of a separate category. This applies to policies from the Bronze category and up. If you have a Basic or Basic Plus policy, check your PHIS to see if you’re covered.

Given the potential complexity of the procedure with individual fees from the surgeon, anaesthetist and hospital, it’s often worth 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.

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When budgeting, keep in mind your private health cover may have an excess, which in some cases can be up to $750 for singles and $1,500 for couples and families. It’s also worth noting that a waiting period may apply from when you take out the cover, before you can make a claim for grommet surgery. Some policies have 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.

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