From its accidental origins in 1649 to the modern techniques used today, myringotomy and insertion of grommets has evolved significantly. A myringotomy, an incision of the tympanic membrane, is a common procedure to drain fluid from the middle ear. After a myringotomy, grommets — small ventilation tubes are often inserted to facilitate middle ear ventilation. Today, this procedure is one of the most frequently performed ENT surgeries and is primarily used to treat conditions like otitis media with effusion and recurrent otitis media. The use of myringotomy and grommets has evolved significantly over time. The first recorded myringotomy was performed in 1649 by the French anatomist Jean Riolan the Younger. This procedure resulted from an accidental injury in which a patient's eardrum was pierced while cleaning the ear canal. The popularity of myringotomy surged in the 19th century, but it was often overused by individuals lacking formal medical training. These practitioners promoted the procedure as a universal remedy for deafness, though most patients saw little to no improvement. This led to a decline in its acceptance and use. Additionally, a key limitation was that the incisions healed quickly. This reduced their potential benefit and fuelled further scepticism about the procedure's value. In 1954, American surgeon Beverley Armstrong developed the first modern grommet. This innovation proved successful and myringotomy with insertion of grommets became the preferred treatment for otitis media with effusion. Today, myringotomy with grommet insertion remains one of the most performed surgeries in children.