Double Grommet Insertion

Harpreet Singh Kochar

A 60 year old lady presented with left ear blockage and decreased hearing. She was having OME and was started on management of the same with conservative approach. There were no nasal symptoms. After two weeks, there was no improvement, but infact worsening of retraction so a recommendation for grommet insertion was made. She was lost to follow up.
She presented again three months later with almost atelectatic ear drum with a small air pocket anteriorly and fluid in area of OWN and RWN. An antrioinfrerior quadrant grommet insertion was done. However, the fluid in the posterior mesotympanum did not drain out as there were adhesions between the TM and the promontory that prevented drainage of posterior mesotympanum. I did a double grommet insertion taking care that the incision and the grommet did not disturb the ossicles. The fluid could drain immediately and through the myringotomy the adhesion between the TM and the promontory were broken using a right angle pick. A grommet insertion was done. The TM seemed stable after two months.
Please share how you would manage this. (I am expecting brickbats but please don’t strip me of my degree)

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