Tympanostomy tube, also known as a myringotomy tube or grommet.

It is a small tube inserted into the eardrum in order to keep the middle ear aerated for a prolonged period of time, and to prevent the accumulation of fluid in the middle ear.

The insertion the tube involves a myringotomy and is performed under local or general anesthesia.

Recurrent otitis media is the principal indication for  tympanostomy tube placement, the most frequently performed operation in children after the newborn period.
In 2006, 667,000 children younger than 15, and mainly under three years, underwent tympanostomy placement.

The tube itself is made of plastics like Teflon or silicone and is shaped like a grommet.

When it is necessary to keep the middle ear ventilated for a very long period,

A T- shaped tube may be used for prolonged ventilation as these tubes can stay in place for 2–4 years.

Grommets are most commonly used to help improve hearing for children who have persistent otitis media with effusion.

Grommets are used for preventing ear infections in children who have frequent middle ear infections.

Grommets are temporary and often fall out after 12–14 months when the ear heals.

Grommets can be used for barotrauma, for prevention of recurrent episodes after air travel, or hyperbaric chamber treatment.

In children who have only one episode of otitis media with effusion (OME) that lasts less than 3 months, grommets

should not be inserted.

Ear discharge is common in 25-75% of children after grommets are inserted.

The risk of having tympanic membrane perforation following the procedure has been estimated at 2%.

Tympanostomy complications:

Tympanic membrane perforation

Blockage of the tympanostomy tube (7%),

Formation of granulation tissue (4%),

Grommet falls out too early (4%), and the tympanostomy tube may move towards the middle ear (0.5%).

Grommets improving drainage in the ear and allow air to circulate in the ear.

Tympanic tube placement improves hearing in children with glue ear and may lead to fewer middle ear infections in children who have regular episodes of acute otitis media.

Tympanic tubes can be used to apply antibiotics drops in children with persistent middle ear infections.

The insertion of tympanostomy tubes accounts for more than 20% of all ambulatory surgery in children under 15 years.

Once the tympanic membrane is numb a small incision is made and the tube is placed in less than 500 ms.

The tubes generally remain in the eardrum for six months to two years, with T-tubes lasting up to four years.

They generally spontaneously fall out of the eardrum.

The eardrum usually closes without a residual hole.

In a small number of cases a perforation can persist.

The counterbalancing view of tympanostomy tube placement includes the cost, risks in possible late sequelae of  anesthesia in young children, possible occurrence of refractory tube otorrhea, tube blockage, premature extrusion, or dislocation of the tube into the middle ear cavity, structural tympanic membrane sequelae, and possible development of mild conducting hearing loss.

Among children 6-35 months of age with recurrent acute otitis media, the rate of episodes of acute otitis media during a two-year period was not significantly lower with tympanostomy tube placement than with medical management (Hoberman Alejandro).

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