Consent: Insertion of Grommets - Podcast Version 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x 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. Adapted from BruceBlaus, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons Figure 1Illustration 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 Frequent questions What is the purpose of inserting grommets in the ear? Grommets are small plastic tubes inserted into the tympanic membrane to facilitate air passage and prevent fluid accumulation, which can lead to glue ear. This procedure is typically performed under general anaesthesia or sedation. What are the common complications associated with grommet insertion? The most frequent complications include infection, bleeding, and early grommet extrusion. Infection occurs in about 5% of cases and can present as non-painful ear discharge. How long do grommets typically remain in place? Grommets usually stay in the tympanic membrane for about 6 to 18 months before they fall out naturally. Their duration can vary based on individual anatomical factors. What are the potential risks during the grommet insertion procedure? Intra-operative risks include bleeding from microsuction trauma or difficulty in inserting the tube due to anatomical variations. Proper techniques, such as using an appropriate ear speculum, can help mitigate these risks. What measures can be taken to prevent complications after grommet insertion? To reduce the risk of complications like infection and bleeding post-operatively, patients should use antibiotic ear drops and adhere to strict water precautions. Careful monitoring and management are essential for optimal recovery. Rate This Article