A grommet is a miniature plastic tube that is placed inside an especially created hole in the eardrum so as to let the air get in and out and improve ventilation of the middle ear.
Myringotomy with grommet insertion is conducted in patients suffering from a condition called glue ear i.e. fluid accumulation in the ear, or those with a retracted eardrum.
Such conditions afflict children more than they do the adults and have an adverse effect on hearing and speech faculties of the patient.
Grommets can remain inside the ear for 6 months to a year (sometimes longer). As the eardrum grows, grommets fall out by themselves and this extrusion is rarely noticed.
Are there any possible complications of Myringotomy with Grommet Insertion?
- Like any surgery, a myringotomy with grommet insertion too comes with plenty of benefits as well as some degree of risk. The risks of this procedure are as follows:
- Infection: Grommets or tubes are placed in the ear to restore normal ventilation and air pressure equalization in the ear canal. Patients with infected ears will have drainage of infection through the grommets that can stretch over many days. Some cases may require further antibiotic treatment (sometimes direct administration into the ear through the grommet) till all the infection is cleared up. The child may still be prone to ear infections in future, especially during a cold, but the frequency should go down and the treatment should also be easier.
- Early extrusion: The grommets inserted in the ear are likely to remain in place for 6 months to 1 year which, in most cases, is sufficient time for the ear to outgrow its infection catching tendency. However, sometimes the grommets are pushed out by the eardrum sooner than intended.  This can increase the chances of a repeat procedure for insertion of fresh grommets.
- Permanent perforation: As we have explained earlier, the grommet is pushed through a tiny hole created in the eardrum by the surgeon. While this hole heals itself after the grommet is pushed out, in 1 or 2 patients in every 100, the hole may not self-heal and may need a repairing surgery which is a very safe and sure procedure. However, if the grommet is designed for long-term insertion (designed to stay in for many years), the risk of a permanent hole in the eardrum becomes higher.
- Hearing: Grommet insertion is an extremely safe surgery. It not only does not affect normal hearing, it also rectifies any hearing loss caused by fluid accumulation or infection behind the eardrum. In small children undergoing this procedure, pre-surgery hearing is not fully measured hence, accurate hearing assessment can only be given after they grow up some more.
How does an ENT Surgeon perform a Myringotomy with Grommet Insertion?
In children, this surgery is mostly performed under a short-duration general anesthesia. The surgeon creates a small nick in the eardrum and a grommet is slipped through and secured.
As more often than not, the underlying condition affects both ears, the same procedure is repeated in the other ear as well. As the eardrum grows, the grommets fall out on their own and need to be taken out surgically only in rarest of rare cases.
At times, extrusion of a grommet leaves behind a tiny hole that mostly heals up on its own without needing any surgical closure (in some cases, it may require a further surgery). While the grommet can cause some scarring in the eardrum, it has no adverse effect on the hearing ability.