Grommet Insertion

Setting

  • WIPER  (wash hands, introduce yourself, permission, expose patient, reposition)  

  • Ask if the patient is happy to see you


Perception

  • Check what the patient understands so far

  • What symptoms are they having and what treatments they have tried so far

  • Offer options including surgery and alternatives


Invitation 
  • Ask if they would like to know more about the operation

  • Ask permission to take consent

  • Explain you will outline the procedure, alternatives, risks and benefits, recovery time.

  • ‘If at any point you have any questions feel free to interrupt me, but I’ll also ask you afterwards if you have any questions’


Knowledge

  • Explain procedure

  • Draw diagram

  • Explain alternatives

  • Intended benefits

  • Potential risks and complications

    • With any operation, risk of bleeding, infection, pain, risk of GA – anaesthetist will be able to go through in more detail. See General Risks below

    • Also specific risks associated with this operation. 

      • Early extrusion

      • Prolonged retention

      • Residual perforation on extrusion

      • Recurrence of glue ear/retraction

      • Loss into middle ear

    • Individual risks to patient

 

Post op


  • Post op advice

    • Most likely to be day case procedure

    • Important to avoid heavy lifting, sneezing, blowing nose, getting water into the ear canal

    • Can swim but no diving under water, even with swim moulds

    • May need to take course of topical drops

    • ?time off work or school – give sick note

    • Contact department/attend A&E if: ear discharge, fever or pain not responding to analgesics

  • Follow up advice

    • See back in clinic in 2-3 months with audiometry

Summary


  • Summarise consultation

  • Offer opportunity to ask questions

  • Offer patient information leaflet

  • Thank patient, wash hands and close


General Risks

  • Bleeding and bruising

  • Infection

  • Pain

  • Scar

  • Risk of general anaesthesia

  • Further surgery

  • Return to theatre

  • Recurrence

  • Suboptimal outcome

  • Numbness

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