Myringotomy and Grommet Insertion

Glue-ear (secretory otitis media) is a common condition effecting children and adults. It is more common in children. In this condition, fluid or mucous is trapped in the middle ear cleft. This is thought to be due to a blockage or narrowing of the Eustachian tube which connects the middle ear to the back of the nose (Nasopharynx). As a result of the fluid accumulation, the patient usually suffers from a hearing loss and may have repeated ear infections. In some cases, the children have balance difficulties and may complain of noises in their ears (tinnitus). Adenoid enlargement is commonly found to contribute to the obstruction, and it may be necessary to treat this at the same time.

I regularly prescribe medications in an attempt to resolve the fluid. I also recommend the regular use of an Otovent balloon to ventilate the middle ear via the nose and Eustachian tube.

However, a number of patients do not respond to conservative treatment and require surgery. I then perform myringotomies (micro-incision of the eardrum) and insertion of temporary ventilation tubes (grommets). The procedure is usually performed under general anaesthesia as a day case. Adenoidectomy (surgical removal of the Adenoids) may be performed at the same time as grommets insertion.

Grommets usually stay in place for between 6 months and 2 years following which they naturally extrude. Very few have to be removed by the surgeon. Grommet insertion is a very good and minimally invasive way of treating glue-ear effectively, however 1 in 10 operations have to be repeated as the fluid can return after the grommets extrude.

In cases of repeated glue-ear formation, especially where there is a chronic under-ventilation of the middle ear, it may be necessary to insert a long-stay ventilation tube. This type of tube is designed to remain in place for over 3 years. I have a special interest in treating patients with this condition and have designed a useful modification to this operation with improved results.