Myringotomy with Grommet Insertion

🦻 Myringotomy with Grommet Insertion

Myringotomy with grommet insertion is a common ENT surgical procedure, especially in children.

🩺 What is Myringotomy?

Myringotomy is a surgical procedure in which a small incision is made in the tympanic membrane to evacuate fluid from the middle ear.

🔩 What is Grommet Insertion?

A grommet (ventilation tube) is placed into the myringotomy incision to:

• Ventilate the middle ear

• Maintain aeration

• Allow continuous drainage

➡️ Myringotomy and grommet insertion are usually performed together.

What are the aims of Myringotomy & Grommet Insertion?

✅ Indications of Myringotomy and Grommet Insertion

• Otitis Media with Effusion (OME) – Primary Indication

What are the indications of Myringotomy and Grommet Insertion in Otitis Media with Effusion (OME)?

• Recurrent Acute Otitis Media

What is Recurrent Acute Otitis Media?

📘 In my detailed notes, I’ve discussed an exhaustive list of Intraindications of Myringotomy and Grommet Insertion.

🚫 Contraindications of Myringotomy and Grommet Insertion

❗ Absolute Contraindications

• Only hearing ear
• Intra tympanic glomus tumor

⚠️ Relative Contraindications

• Acute otitis externa
• Atrophic tympanic membrane

📘 In my detailed notes, I’ve discussed an exhaustive list of Absolute and Relative Contraindications of Myringotomy and Grommet Insertion.

💉 Anesthesia

• Adults: Local anesthesia

  • 1% lignocaine + adrenaline (1:100,000)

• Children: General anesthesia (preferred)

🛏️ Patient Position

• Supine position
• Head on ring
• Operating ear turned toward surgeon

🛠️ Surgical Steps of Myringotomy and Grommet Insertion

🔍 Preparation

• Operating microscope (6× magnification)
• Clean external auditory canal
• Ensure blood-free field

What is the maginification required on microscope for Myringotomy and Grommet Insertion?

✂️ Myringotomy Incision

• Type: Radial incision
• Length: 2-3 mm
• Site: Anteroinferior quadrant

Why is radial incision given in Myringotomy for Otitis Media with Effusion (OME)?

Why is anteroinferior quadrant preferred in Myringotomy for Otitis Media with Effusion (OME)?

🧹 Suction Clearance

• Aspirate middle ear fluid gently
• Avoid continuous suction
• Thick glue may drain via tube later

🔩 Grommet Insertion

• Grasp with crocodile forceps
• Insert with leading edge forward
• Position inner & outer flanges correctly
• Ensure hemostasis
• No routine packing required

🔄 Removal of Grommet

Usually spontaneous extrusion

What are the indications for Removal of Grommet?

🧑‍⚕️ Post-operative Care of Myringotomy and Grommet Insertion

• Day care procedure

• Avoid water entry into ear

• Nasal decongestants × 5 days

• Avoid forceful nose blowing

• Ear protection during swimming

• Follow-up:

  • 1-4 weeks
  • Every 3 months

• Repeat audiometry & tympanometry

⚠️ Complications of Myringotomy and Grommet Insertion

🛠️ Intra operative

• Bleeding
• Tube displacement into middle ear
• Ossicular injury

⏱️ Early Post operative

• Otorrhea (most common)

🕰️ Late Post operative

• Persistent TM perforation

📘 In my detailed notes, I’ve discussed an exhaustive list of Complications of Myringotomy and Grommet Insertion.

📌 Viva Pearls

• Radial incision in OME
• Preferred quadrant: antero-inferior
• Type B tympanogram
• Tubes usually extrude spontaneously
• Unilateral OME in adults → malignancy workup