About this page. Detailed consent information for grommet insertion under general or local anaesthetic. Grommets bypass the underlying problem (Eustachian tube dysfunction or glue ear) rather than treating its cause — see Eustachian Tube Dysfunction for the bigger picture.
What the Operation Is
A grommet (also called a tympanostomy tube or ventilation tube) is a small hollow plastic tube inserted into the tympanic membrane (eardrum). It can be placed under general anaesthetic (more common in children) or local anaesthetic (in selected adults).
The function of the grommet is to ventilate the middle ear — the air-filled space behind the eardrum that normally relies on the Eustachian tube for ventilation and drainage. When the Eustachian tube is not working properly (because of allergies, infection, anatomy, or unknown reasons), the middle ear becomes negative-pressure and may fill with fluid. This causes muffled hearing, pressure sensation, recurrent ear infections, and (in children) speech delay. A grommet allows air to enter the middle ear directly through the eardrum, bypassing the dysfunctional Eustachian tube.
Importantly, grommets do not treat the underlying problem; they bypass it while the Eustachian tube continues to malfunction. Many children will outgrow their Eustachian tube problems naturally during the time a grommet is in place; adults may need repeat grommets if the dysfunction persists, or may be candidates for Eustachian tube balloon dilatation.
Risks & Complications
1. Bleeding
Bleeding from the ear can occur in the first 48 hours but generally settles without intervention. A small amount of blood-stained fluid on the pillow overnight is normal.
2. Middle ear infection
Having an open communication into the middle ear increases the chance of middle-ear infection — typically presenting as copious watery or pus-like discharge from the ear rather than pain or blockage. Most cases settle with ear drops; occasionally the grommet becomes the source of infection and needs to be removed in a separate operation.
3. Pain
Under general anaesthetic, grommet insertion is essentially painless. Under local anaesthetic, the only discomfort is the initial injection of the anaesthetic. The procedure is rather noisy under local anaesthetic — moving the eardrum stimulates the hearing apparatus, and some patients find this so distressing that they require general anaesthetic to complete the operation.
4. Imperfect hearing
Having a piece of plastic in the eardrum means hearing is not absolutely perfect, although this is rarely noticeable in everyday life. After being partially deaf for a long time, some patients describe an echoing sensation as they readjust to clearer hearing — this usually resolves over a few weeks.
5. Grommets remain in place too long
Grommets normally stay in place for about 9 to 18 months before the eardrum's natural growth pushes them out. If they do not fall out naturally, they become permanent — this happens in approximately 1% of cases. Long-term grommets are available but should be replaced every four years or so.
6. Persistent perforation
In approximately 1% of cases the grommet leaves a hole in the eardrum that does not heal — effectively a perforation. This may need surgical repair with a myringoplasty or cartilage tympanoplasty.
7. Blocked grommet
In approximately 1% of cases the grommet becomes blocked with debris and stops working. It may need to be cleaned or replaced.
8. Lack of success
I cannot guarantee that any operation is completely successful. A small number of patients have ongoing symptoms despite a functioning grommet.
9. Anaesthetic risks
Standard general-anaesthetic risks apply if a general is used; these will be discussed by the anaesthetist.
Aftercare
- Keep the ear dry for at least one to two weeks. Swimming pools, hair washing and shower water should be avoided or ears protected with a tight-fitting cap or earplugs. After that, your surgeon's specific advice applies — many ENT surgeons (including me) now allow ordinary water exposure once the eardrum has healed around the grommet.
- Painkillers are rarely needed.
- Ear drops are sometimes prescribed for a few days to prevent infection.
- Hearing improvement is usually noticeable within days. The "echo" sensation, if it occurs, resolves within a few weeks.
- Follow-up is usually arranged at 6 weeks and 6 months to check the grommet is in place and working.
When to Call the Hospital or Attend A&E
- Heavy bleeding from the ear that does not settle.
- Persistent discharge for more than a few days despite ear drops.
- Severe ear pain not relieved by simple painkillers.
- Sudden change in hearing.
- Dizziness or vertigo.
Booking, Consent and Next Steps
If you are considering grommet insertion, the secretarial team can arrange a consultation. See also Eustachian Tube Dysfunction, Eustachian Tube Balloon Dilatation Consent, and Myringotomy Consent.