Myringotomy and Grommet Insertion

Indications

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).

Procedure

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.

Operative time

Up to 10 mins per ear.

Complications

Discomfort (mild)

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.

Post-operative management

Patients are discharged the same day, and followed up routinely with an audiogram.

TTO

Simple analgesia only if required. Occasionally, patients need ear drops to take home (check the op note); there is some evidence that a single application or short course of drops reduces immediate ear discharge.

 Page last reviewed: 4 January 2023