Ear Grommets

Myringotomy and grommet placement

A myringotomy is an incision made into the eardrum
In most cases the ear grommet is placed into the incision, allowing drainage of the fluid that can build up in the middle ear
As a result of this procedure, ventilation of the middle ear is re-established, hearing is improved, and recurrent ear infections are treated
Each year, myringotomy and grommet placement is the most common childhood surgery performed with anaesthesia – the average age of children who have grommet surgery is one to three years old

Ear grommets are tiny tubes placed through the ear drum to allow air into the middle ear
These tubes can be made out of plastic, or in most cases Teflon and may have a coating intended to reduce the possibility of infection
There are two basic types of grommets:
- Short-term
  - Short-term tubes are smaller and typically stay in place for six months to a year before falling out on their own
- Long-term
  - Long-term tubes are larger and have flanges that secure them in place for a longer period of time

Picture showing a grommet in place in the ear drum, the middle ear and Eustachian tube

Ear grommets are inserted through a day surgery procedure called a myringotomy
This is most often done under a surgical microscope with a small scalpel (tiny knife)
If a grommet is not inserted, the hole would heal and close within a few days
To prevent this, a grommet is placed in the hole to keep it open and allow air to reach the middle ear space (ventilation)

A light general anaesthetic (laughing gas) is administered for young children
Some older children and adults may be able to tolerate the procedure without anaesthetic
A myringotomy is performed and the fluid behind the ear drum (in the middle ear space) is drained out
The grommet is then placed in the hole
Ear drops may be administered after the grommet is placed and may be necessary for a few days
The procedure usually lasts less than 15 minutes and patients awaken quickly
Sometimes removal of the adenoid tissue (lymph tissue located in the upper airway behind the nose) will be recommended at the same time.
This is often considered when a repeat grommet placement is necessary
Current research indicates that removing adenoid tissue together with placement of ear grommets can reduce the risk of recurrent ear infection and the need for repeat surgery

Myringotomy with placement of ear grommets is an extremely common and safe procedure with minimal complications – when complications do occur, they may include:
- Perforation – This can happen when a tube comes out or a long-term tube is removed and the hole in the tympanic membrane (ear drum) does not close – the hole can be patched through a minor surgical procedure called a tympanoplasty or myringoplasty
- Scarring – Any irritation of the ear drum (recurrent ear infections), including repeated placement of grommets, can cause scarring called tympanosclerosis or myringosclerosis – in most cases, this causes no problems with hearing
- Infection – Ear infections can still occur in the middle ear or around the grommet, however, these infections are usually less frequent, result in less hearing loss, and are easier to treat – often only with ear drops
- Grommets may come out too early or stay in too long – If a grommet expels from the ear drum too soon (which is unpredictable), fluid may return and repeat surgery may be needed – grommets that remain too long may result in perforation or may require removal

After surgery, the patient is monitored in the recovery room and will usually go home within an hour if no complications are present
Patients usually experience little or no postoperative pain but grogginess, irritability, and/or nausea from the anesthesia can occur temporarily
Hearing loss caused by the presence of middle ear fluid is immediately resolved by surgery
Sometimes children can hear so much better that they complain that normal sounds seem too loud

Recent research suggests that protecting the ear from getting wet after grommet placement, may not be necessary, except when diving or engaging in water activities in unclean water such as public swimming pools, lakes and rivers
Where needed a silicone swim cap and ear plugs should prevent water entering the ears during swimming

Ear grommet placement will occasionally cause some discomfort and panadol (not aspirin) is recommended for pain relief, according to the recommended dosage on the label
Occasionally a small amount of blood may be noticed in the ear canal – this comes from the incision in the eardrum and is normal
Antibiotic ear drops are sometimes prescribed – use as directed (drops should be used at room temperature and stored in the refrigerator between use)
Absolutely no water in the ears for the first 72 hours after placement – use a piece of cotton coated with Vaseline or ear plugs in the ears when bathing or showering
Children may return to school and adults may return to work the day following surgery

Usually the presence of grommets causes no pain
Ear pain is one of the first signs of infection – another sign of infection is drainage from the ear
- If this occurs concerns you should visit your local doctor who will contact your surgeon
- Begin Ciloxan ear drops – 3 drops/2 times a day and arrange to see your ENT specialist for an ear check
Do not use cotton buds to clean the ear canal or remove wax