Intra-tympanic membrane bleeding after grommet insertion and tympanosclerosis

The aetiology of tympanosclerosis following grommet insertion remains controversial. In this study tympanosclerotic changes of the tympanic membrane in 92 ears were shown to be related to the presence of intra-epithelial haemorrhage shortly after myringotomy with grommet insertion (P less than 0.01) and to the grommet being in situ on follow-up 6 months later (P less than 0.025). Ears in which haemorrhage was absent and where the grommet had extruded did not develop tympanosclerosis. These findings would indicate that bleeding, if causally implicated is not the sole aetiological factor, but careful attention to surgical technique to reduce this may subsequently minimize the development of tympanosclerotic changes.