Myringotomy and Grommet Insertion
Glue ear (otitis media with effusion) leading to bilateral conductive hearing loss >25-30dB, persistent over 3 months (see NICE guideline CG60).
Occasionally in recurrent acute otitis media (controversial).
Occasionally for other problems such as tympanic membrane retraction, Eustachian tube dysfunction, Meniere’s disease (controversial).
Using a microscope to visualise the tympanic membrane, a radial incision (myringotomy) is made in the antero-inferior quadrant. Any fluid in the middle ear is suctioned out, and a grommet (ventilation tube) is inserted into the myringotomy.
This is often performed under local anaesthesia in adults.
Up to 10 mins per ear.
Bleeding (spots) or other discharge
Infection Patients should maintain water precautions when bathing/swimming whilst grommets are in place. An infection with a grommet in situ usually presents with painless yellow mucoid discharge. It is best treated with ciprofloxacin drops, as systemic antibiotics will not kill the bacterial biofilm on the grommet itself. Repeated, hard-to-treat infection occasionally leads to grommet removal.
Early/late extrusion Grommets are temporary, and typical grommets stay in place for 6-18 months before they are extruded.
Persistent perforation The tympanic membrane will usually heal over once the grommet extrudes. This occasionally fails to happen – especially if extrusion is late or infection is present. A few patients require myringoplasty to repair a persistent perforation.
Tinnitus and dizziness Occasionally present but usually short-lived.
Failure to improve/hearing loss Rare but should be mentioned.
Patients are discharged the same day, and followed up routinely with an audiogram.
Simple analgesia. Occasionally ear drops are prescribed (no evidence that they prevent infection, but may decrease early grommet blockage).
Page last reviewed: 21 September 2017