What are the indications for grommet insertion post adenoidectomy..(ma'am means which symptoms to look for the insertion of grommet)?

Grommet insertion, also known as tympanostomy tube placement, is often performed in conjunction with adenoidectomy in children who have persistent middle ear problems. The primary indications for grommet insertion post-adenoidectomy are related to ongoing issues with middle ear ventilation and recurrent or chronic otitis media. Here are the symptoms and indications to look for:

Indications for Grommet Insertion Post Adenoidectomy

  1. Recurrent Acute Otitis Media (RAOM):
  • Defined as three or more episodes of acute otitis media within six months, or four or more episodes within a year.
  • Children who continue to have frequent episodes of acute otitis media despite adenoidectomy may benefit from grommet insertion.
  1. Chronic Otitis Media with Effusion (OME):
  • Persistence of middle ear effusion (fluid) for more than three months.
  • Presence of effusion in both ears for more than three months, particularly if associated with significant hearing loss.
  1. Hearing Loss:
  • Documented conductive hearing loss due to middle ear effusion that affects the child’s ability to hear, speak, and learn.
  • Hearing loss that persists despite initial adenoidectomy.
  1. Middle Ear Problems Despite Adenoidectomy:
  • Persistent or recurrent symptoms of middle ear dysfunction, such as ear pain, pressure, or fullness.
  • Balance problems or recurrent ear infections that continue despite the removal of adenoids.
  1. Eustachian Tube Dysfunction:
  • Persistent eustachian tube dysfunction that leads to the chronic presence of middle ear effusion or recurrent infections.
  • Symptoms like frequent ear popping, clicking, or discomfort due to poor ventilation of the middle ear.

Symptoms to Look For

  1. Persistent Ear Infections:
  • Multiple episodes of ear infections within a short period.
  • Symptoms include ear pain, fever, irritability, and ear discharge.
  1. Hearing Issues:
  • Difficulty hearing or responding to sounds.
  • Speech and language development delays.
  • Frequently asking for repetition or appearing inattentive.
  1. Ear Pain or Discomfort:
  • Ongoing ear pain, pressure, or fullness that does not resolve after adenoidectomy.
  1. Behavioral Changes:
  • Changes in behavior that may be related to discomfort or hearing problems, such as irritability or difficulty concentrating.
  1. Balance Problems:
  • Issues with balance or frequent falls that may be related to chronic middle ear effusion.


Grommet insertion post-adenoidectomy is indicated for children who continue to experience recurrent or chronic middle ear problems, hearing loss, or other symptoms of middle ear dysfunction despite initial adenoidectomy. Identifying these symptoms early and consulting with an otolaryngologist can help determine the need for grommet insertion to improve the child’s quality of life and developmental outcomes.