---
title: "Myringotomy with Grommet Insertion"
description: "ENT notes on Myringotomy with Grommet Insertion - Indications, Contraindications, Procedure, Postoperative care, and Complications."
source: "The ENT Resident"
author: "Dr. Mausumi Das"
canonical_url: "https://www.theentresident.com/ent-notes-lectures/myringotomy-grommet-insertion"
categories: ["Otology", "Surgery"]
video: "https://www.youtube.com/watch?v=T-L2rv5_oWE"
image: "https://media.theentresident.com/og-images/myringotomy-grommet-insertion.png"
---

# Myringotomy with Grommet Insertion

ENT notes on Myringotomy with Grommet Insertion - Indications, Contraindications, Procedure, Postoperative care, and Complications. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=T-L2rv5_oWE

## 🦻 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.

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### 🔩 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?

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### ✅ 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.

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### 🚫 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.

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### 💉 Anesthesia

- **Adults**: Local anesthesia  
  - 1% lignocaine + adrenaline (1:100,000)

- **Children**: General anesthesia (preferred)

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### 🛏️ Patient Position

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

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### 🛠️ 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?
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#### ✂️ 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)?

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#### 🧹 Suction Clearance

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

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#### 🔩 Grommet Insertion

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

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### 🔄 Removal of Grommet

Usually **spontaneous extrusion**

> What are the indications for Removal of Grommet?

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### 🧑‍⚕️ 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.

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### 📌 Viva Pearls

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

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## About This Note

This free ENT note on Myringotomy with Grommet Insertion was written by Dr. Mausumi Das and is paired with a corresponding video lecture.

Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/myringotomy-grommet-insertion

When citing or referencing this content, please credit The ENT Resident and link to the canonical page above.

## Related Notes by Category

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- Surgery: https://www.theentresident.com/ent-notes-lectures/category/surgery.md

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