This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent.
Overview of Procedure
A grommet is a small plastic tube that sits in the tympanic membrane. Its main goal is to allow air to pass in and out of the ear, preventing the development of fluid that causes glue ear. This operation can be done under general anaesthesia or sedation, usually as day case surgery.
A small opening is made in the tympanic membrane using a microscope, with the fluid sucked out of the middle ear with a fine sucker. The grommet is then placed in the opening in the tympanic membrane. Whilst it varies from person to person, grommets will usually fall out after 6-18 months.
Figure 1 – Illustration of a Grommet In-Situ
Complications
Intra-Operative
| Complication | Description of Complication | Potential Ways to Reduce Risk |
| Bleeding | Bleeding in the external auditory canal, either from microsuction trauma or myringotomy | Use of ear wax softener before the operation, careful microsuction, and use a radial myringotomy incision |
| Failure to insert the tube | Difficulty/failure of inserting the tube due to anatomical factors | Using the appropriate ear speculum |
| Grommet falling into middle ear | Appropriate fashioning of the myringotomy size |
Early
| Complication | Description of Complication | Potential Ways to Reduce Risk |
| Bleeding | Antibiotics ear drops and strict water precautions post-operatively | |
| Infection | This is the most common complication (5%) and it usually presents with non-painful otorrhoea | Antibiotics ear drops and strict water precautions post-operatively |
| Early grommet extrusion | The tube could fall out before 6 months |
Late
| Complication | Description of Complication | Potential Ways to Reduce Risk |
| Tympanosclerosis | Scarring of the tympanic membrane | Avoid excessive microsuction on the tympanic membrane |
| Residual tympanic membrane perforation | 1-2% risk of residual tympanic membrane perforation after the grommet comes out | |
| Failure to improve the hearing | Careful scrutinising of preoperative investigations, to ensure no concurrent pathology | |
| Recurrence of glue ear | More likely to occur with early grommet extrusion |