Myringotomy Grommet

The pre-operative checklist is as follows: –

• Make sure that the child stops taking any food six hours prior to the surgery.
• Till the preceding night of the surgery, ensure that the child takes all the medications prescribed by the ENT surgeon.
• Bring along any prescription or non-prescription medicines the child is taking (in original packaging/bottles) before checking in for surgery the next morning. If the child is using an inhaler or a breathing device, bring along that too.
• Bring along special formula/breast milk for post-operative feeding of the infant.
• A child can bring along a favourite comfort item – blanket, stuffed animal, or pacifier etc. – which will be allowed inside the Operating Room and the Post-Operative Recovery Room. Children can also bring along movies, books or games if they will be staying at the hospital overnight or through the day.
• Parents should be prepared to dedicate the entire day to their child’s surgery and recovery. 
• Please make sure to report at the hospital at least three hours prior to the surgery’s scheduled timing.
• Report at the reception desk in time and the hospital staff will guide through the next steps.
• If there are any changes in the child’s physical condition such as cough, cold, fever or throat pain, be sure to mention it to the doctor and anaesthetist. If the child is allergic to any drugs, the doctor should be informed about that as well.

• The child should take complete bed rest on the day of the surgery.
• The child will not be allowed any drink or food till 4-5 hours after the surgery. After that the child can be given water to sip. A while later milk or Horlicks etc. can also be given. However, caffeinated beverages such as tea, coffee or aerated drinks are to be avoided. Semi-solid diet in moderate quantities is to be started after 12 hours. Normal food is allowed from second day onwards.
• While grommets usually do not hurt at all, a child can still be given painkillers if required.
• As up till the surgery, the child has been living with lowered hearing, post-surgery they may find every sound as ‘too loud’. It may take them a few days to get acclimatized to normal hearing.
• In most cases, the child can return to school/ playschool the day after the surgery.
• Do not let any water get into the operated ears for at least two weeks after the day of surgery.
• A child can take up swimming, two weeks after the surgery and that too without using earplugs. However, dirty or soapy water in the ear has to be avoided totally, so diving under the water is out of bounds completely. At the time of bathing or showering, the child’s ear holes will have to be covered with Vaseline petroleum jelly covered cotton balls.
• Parents must ensure that all the medications prescribed to the child are duly taken.

After the child is discharged from the hospital, he/she will have to brought for a routine check-up after 7 days. Any follow up visits will be as advised by the operating surgeon.

• 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 equalisation 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: While this hole through which the grommet is pushed, 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: 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.