Grommet Removal — Cost, Top Hospitals & Success Rates | MyMedicPlus

A grommet (also called a tympanostomy tube, ventilation tube, or pressure-equalising tube) is a tiny hollow cylinder inserted through the tympanic membrane (eardrum) to ventilate the middle ear. Grommets are among the most commonly performed surgical procedures in children worldwide, primarily used to treat chronic otitis media with effusion (glue ear) and recurrent acute otitis media.

Most short-term grommets are made of biocompatible polyethylene or silicone and are designed to stay in place for 6 to 18 months before being naturally extruded as the epithelium of the eardrum migrates outward. Long-term grommets (T-tubes, Goode tubes) are intentionally retained for several years and usually require surgical removal. Once the grommet falls out or is removed, the eardrum heals in the vast majority of cases within a few weeks.

Grommet removal therefore refers to either the spontaneous natural process or the deliberate surgical excision of a retained or problematic tube. The clinical decision to intervene is guided by the duration the grommet has been in situ, the presence of complications such as granulation tissue, cholesteatoma, or persistent perforation, and the patient's overall ear health.

This guide explains when and how grommets are removed, what complications can arise, what patients should expect during recovery, and which alternatives exist for managing ongoing middle-ear problems.

Understanding why grommets are inserted helps explain the circumstances under which removal becomes relevant.

Indications for Original Grommet Insertion

• Chronic otitis media with effusion (OME / glue ear): Persistent fluid in the middle ear lasting more than three months, associated with conductive hearing loss of ≥25 dB, speech delay, or learning difficulties in children.
• Recurrent acute otitis media (AOM): Three or more episodes in six months, or four or more episodes in twelve months, unresponsive to antibiotic prophylaxis.
• Eustachian tube dysfunction: Chronic negative middle-ear pressure, retraction pockets, or barotrauma (aviation, diving).
• Cleft palate: Structural eustachian tube dysfunction necessitating long-term ventilation.

Situations Requiring Deliberate Grommet Removal

• Retained grommet for longer than two years (short-term tube) or beyond the planned duration (long-term tube).
• Granulation tissue or polypoid change around the grommet causing otorrhoea unresponsive to topical antibiotic drops.
• Grommet malposition migrating towards the umbo or becoming partially embedded in the drum.
• Planned tympanoplasty to repair a persistent perforation.
• Recurrent otorrhoea through the grommet despite medical management.

Not all retained grommets require active removal. The decision to operate is individualised, balancing the risk of persistent perforation from premature removal against the risk of complications from leaving an aged tube in place.

When Watchful Waiting Is Appropriate

If a short-term grommet is in the lateral eardrum, medically stable, and the underlying condition (glue ear) has resolved, the preferred approach in most paediatric ENT guidelines — including those from the British Association of Otorhinolaryngology (BAO-HNS) and the American Academy of Otolaryngology-HNS — is watchful waiting, as spontaneous extrusion is expected within the stated product lifespan.

Criteria Favouring Surgical Removal

• Grommet retained beyond the manufacturer-specified lifespan (typically 12–18 months for standard tubes, 3–5 years for T-tubes).
• Persistent purulent otorrhoea unresponsive to 4–6 weeks of topical quinolone drops (e.g., ciprofloxacin-dexamethasone).
• Visible granulation tissue, blocked grommet lumen, or circumferential epithelial migration suggesting impending or established cholesteatoma.
• Need for myringoplasty — the grommet must be removed as part of the repair.
• Patient or family preference where the underlying condition has clearly resolved and hearing is normal.

Timing Considerations

Most paediatric ENT surgeons prefer to remove grommets during daylight hours as a planned day-case procedure, avoiding the autumn/winter respiratory season when post-operative AOM risk is highest. For adults with office-accessible tubes, removal can be performed in the outpatient setting under microscopic guidance without anaesthesia.

There are two principal pathways for grommet removal: spontaneous extrusion and surgical excision. The method selected depends on patient age, grommet type, position, and the presence of complications.

1. Spontaneous Extrusion (Natural Removal)

This is the intended outcome for short-term grommets. As squamous epithelium migrates centrifugally across the eardrum, it carries the grommet to the outer ear canal. The patient or parent may notice a small plastic speck in the ear canal. No intervention is required unless perforation persists beyond 3 months after extrusion.

2. Surgical Removal Under General Anaesthesia (GA)

This is the standard approach in children and in adults when office removal is not feasible. Using an operating microscope, the surgeon:

1. Visualises the grommet and assesses the surrounding drum.
2. Grasps the grommet flange with alligator forceps or a hook.
3. Gently extracts the tube with a controlled, smooth movement to avoid tearing the drum.
4. If granulation tissue is present, it is carefully excised and sent for histology.
5. The perforation is assessed — if it is small (≤2 mm), a paper patch myringoplasty may be applied at the same sitting; larger perforations are managed by formal tympanoplasty at a later date.

3. Office Removal in Adults (Under Local Anaesthesia or Without Anaesthesia)

Standard short-term grommets with accessible lateral flanges can often be removed in the outpatient setting under direct microscopy. Topical lignocaine (lidocaine) may be applied to the drum for comfort. This avoids the risks of GA and allows same-day return to normal activities.

4. Concurrent Procedures

Grommet removal may be combined with adenoidectomy (if adenoid hypertrophy is contributing to ongoing eustachian tube dysfunction) or with myringoplasty when a persistent perforation requires formal repair.

Timely and appropriate removal of problematic grommets offers several clinical advantages:

• Prevention of persistent tympanic membrane perforation: Long-term grommets that remain in situ indefinitely carry a higher risk of permanent perforation (up to 15–20% for T-tubes vs 1–2% for standard grommets). Planned removal at the appropriate time reduces this risk.
• Resolution of chronic otorrhoea: Many cases of recurrent ear discharge through the tube resolve once the foreign body is removed and the drum heals.
• Cholesteatoma prevention: Removing a blocked or partially embedded grommet prevents squamous epithelial migration into the middle ear, the precursor to cholesteatoma.
• Restoration of middle-ear anatomy: After removal, the intact eardrum restores normal sound transmission and reduces susceptibility to infection.
• Water precautions no longer needed: Many ENT services advise earplugs during swimming while grommets are in situ. Once the drum has healed, this restriction is lifted, improving quality of life for active children and adults.
• Enables formal hearing assessment: Pure-tone audiometry (PTA) performed after the drum heals gives an accurate baseline of the patient's long-term hearing status, which is not obtainable while the grommet is in place.

Grommet removal is a low-risk procedure, but patients and parents should be aware of the following:

Persistent Tympanic Membrane Perforation

This is the most clinically significant risk. The incidence depends on grommet type and duration:

• Standard short-term grommets: 1–2% persistent perforation rate.
• Long-term T-tubes: 15–20% persistent perforation rate.
• Perforations that have not healed within 3 months are unlikely to close spontaneously and typically require formal myringoplasty.

Intraoperative Bleeding

Minor oozing from the drum edges is common and usually settles within minutes with gentle pressure. Significant haemorrhage is rare.

Infection (Otitis Media)

Post-operative AOM occurs in approximately 5–10% of children within the first month after removal, particularly if removed during the respiratory virus season. Parents are advised to report fever, ear pain, or discharge promptly.

Grommet Displacement or Remnant

Rarely, a fragment of the inner flange may be left behind in the middle ear if the grommet is diseased or partially embedded. This can cause ongoing inflammation and may require re-exploration.

Anaesthesia Risks (Children)

General anaesthesia in healthy children is very safe, with serious complications occurring in fewer than 1 in 10,000 cases. All children undergo pre-operative assessment by a paediatric anaesthetist.

Need for Re-insertion

If glue ear recurs significantly after grommet removal, repeat grommet insertion may be required. This is more common in children with cleft palate or primary ciliary dyskinesia.

Structured follow-up after grommet removal ensures the eardrum heals correctly and that underlying middle-ear conditions do not recur.

Immediate Post-Operative Period (0–2 Weeks)

• Most patients are discharged home on the same day within 1–2 hours of recovery from GA.
• Mild ear discomfort is normal and can be managed with age-appropriate paracetamol or ibuprofen.
• No water should enter the ear until the perforation has healed and this is confirmed by the surgeon — typically 6–8 weeks post-removal.
• Antibiotic ear drops are not routinely required unless granulation tissue was present or a concurrent infection was treated.

First Follow-Up Appointment (6–8 Weeks)

• Otoscopy or otoendoscopy to confirm tympanic membrane closure.
• If perforation has not healed, continued observation for up to 3 months total is warranted before planning myringoplasty.

Audiological Assessment (3 Months Post-Removal)

Once the drum is fully healed, a pure-tone audiogram (PTA) — and tympanometry in younger children — is performed to establish the patient's true hearing thresholds. This is the most important post-removal investigation, as it guides whether further management (hearing aids, myringoplasty) is needed.

Long-Term Monitoring

Children with a history of recurrent OME should receive annual audiological reviews until the age of 8–10 years, as the eustachian tube continues to mature and residual hearing loss can affect educational development.

The cost of grommet removal varies substantially by country, healthcare system, and whether the procedure is performed in an office or operating theatre setting.

Key Cost Drivers

• Setting: Office removal under direct microscopy (adult patients) is significantly cheaper than a formal operating theatre procedure under general anaesthesia. Office procedures typically range from USD 200–600, while surgical removal under GA ranges from USD 1,500–5,000 in high-income countries.
• Anaesthesia fees: Paediatric general anaesthesia adds USD 500–1,500 to the procedure cost in private settings.
• Concurrent procedures: If myringoplasty or adenoidectomy is performed simultaneously, costs increase considerably.
• Hospital type: Private hospitals cost more than public/government facilities. Day-case surgery centres are generally more cost-effective than inpatient hospital settings.
• Country: The same procedure performed in India, Thailand, or Turkey typically costs 60–80% less than in the United States, United Kingdom, or Australia.

Approximate Cost Ranges by Region

• United States: USD 2,500–6,000 (with anaesthesia)
• United Kingdom (private): GBP 1,200–3,000
• India: USD 300–700
• Thailand: USD 500–1,200
• Turkey: USD 400–900

Patients travelling for planned ENT care should ensure the receiving centre has paediatric anaesthesia capabilities, operating microscopes, and audiological testing services.

Depending on the clinical scenario, several non-surgical and conservative strategies may be appropriate instead of, or prior to, planned grommet removal.

Watchful Waiting for Spontaneous Extrusion

If the grommet is functioning, the drum is healthy, and there are no complications, most guidelines favour observation and allowing the tube to extrude naturally. This is the preferred approach for standard grommets within their intended lifespan.

Topical Antibiotic Drops for Otorrhoea

Chronic discharge through the grommet can often be controlled with topical quinolone drops (ciprofloxacin-dexamethasone or ofloxacin) for 7–14 days. This may negate the need for early removal in many cases and is recommended as first-line treatment for grommet otorrhoea by national guidelines (AAO-HNS, 2023).

Water Precautions Without Removal

For patients whose primary concern is water ingress (swimming, bathing), the use of custom-moulded earplugs or cotton wool with Vaseline may be sufficient while the grommet is functional, without requiring premature removal.

Management of Persistent Perforation Without Surgery

For small, dry, asymptomatic perforations after grommet extrusion, office-based paper patch myringoplasty — applying a paper or Gelfilm patch under magnification — can promote healing. Success rates for perforations ≤2 mm are approximately 60–70%.

Re-insertion Rather Than Removal

Where the grommet has extruded or blocked and the underlying condition (OME, eustachian tube dysfunction) has recurred, insertion of a new grommet — rather than removal of the old one — addresses the root cause directly.