Tympanostomy tube | |
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The grommet is less than 2 mm tall, smaller than a match head. | |
Other names | Grommet, T-tube, ear tube, pressure equalization tube, vent, PE tube, myringotomy tube |
Tympanostomy tube, also known as a grommet or myringotomy tube, 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 operation to insert the tube involves a myringotomy and is performed under local or general anesthesia. The tube itself is made in a variety of designs. The most commonly used type 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, as these 'T-tubes' can stay in place for 2–4 years. Materials used to construct the tube are most often plastics such as silicone or Teflon. Stainless steel tubes exist, but are no longer in frequent use.
Medical uses[edit]
Ear tube
Tubes of a more permanent style, unlike those typically used in the United States. These tubes remained in place for four years until one spontaneously left the ear drum. The other was removed with tweezers after having partially disengaged from the ear drum. The removal process can cause significant pain for several minutes.
Inserting grommets is a common surgical procedure for treating children around the world.[1] Grommets are most commonly used to help improve hearing for children who have a condition commonly called 'glue ear' (persistent otitis media with effusion) in both ears, and for preventing ear infections in children who have frequent middle ear infections.[1] Grommets are temporary and often fall out after 12–14 months as the ear heals.[2] Guidelines state that tubes are an option in:
Armstrong Beveled Grommet 2 Ear Ventilation Tube 1.14 mm Internal Dimension - TUBE, EAR VENT ARMSTRONG GROMMETT W/ULTRASIL Armstrong Beveled Grommet 2 Ear Ventilation Tube 1.14 mm Internal Dimension JavaScript seems to be disabled in your browser.
- Recurrent acute otitis media: three ear infections in six months or four infections in a year.[3] The evidence for this recommendation; however, is weak.[3]
- Chronic otitis media with persistent effusion for six months (one ear) or three months (both ears).[citation needed]
- Persistent eustachian tube dysfunction[citation needed]
- Barotrauma: Especially for prevention of recurrent episodes (e.g., after air travel, hyperbaric chamber treatment).[citation needed]
- Grommets should not be inserted in children who have only one episode of otitis media with effusion (OME) that lasts less than 3 months.[4]
Adverse Effects[edit]
Ear discharge (otorrhoea) is common in 25-75% of children after grommets are inserted.[1] Treatments to prevent this discharge before it occurs should be limited to children who have a higher risk of otorrhoea and it is not clear which preventative treatment is better.[5]
The risk of having persistent tympanic membrane perforation following the procedure may be low,[6] and has been estimated at 2%.[2] Other adverse effects are estimated at: 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%).[2] There is also a risk related to general anesthesia.[2]
Long term effects include visible changes to the tympanic membrane.[1] These changes usually resolve on their own and do not usually require medical treatment or result in hearing problems that are clinically significant.[1]
Mechanism of Action[edit]
Grommets work by improving drainage in the ear and allow air to circulate in the ear.[7] Grommet placement has been shown to improve hearing in children with glue ear and may lead to less middle ear infections in children who have regular episodes of acute otitis media.[4] Grommets can be used to apply antibiotics drops in children with persistent middle ear infections.[4]
Procedure[edit]
Although myringotomy with tube insertion can be performed under local anesthesia during a regular doctor's appointment in co-operative adults, patients requiring tube insertion are very often young children. Since damage to the ear is possible unless the patient stays quite still while being manipulated, any patient who may have difficulty lying still during the procedure typically undergoes myringotomy and tube insertion under general anesthesia.
The insertion of tympanostomy tubes is one of the most common surgical procedures performed on children. In the United States, the procedure accounts for more than 20% of all ambulatory surgery in children under 15 years.[2]
For children with ear discharge, antibiotic ear drops may be more effective than antibiotics taken by mouth.[1] It is not clear if antibiotic drops are better than rinsing the ear with saline.[1]
It is usually suggested that children keep their ears dry for the first two weeks after having the procedure.[8] It is not thought to be necessary for children to wear ear plugs when swimming or keep their ears dry after the first two weeks as the potential benefit is very small.[8] It is approximated that a child would need to wear ear plugs for 2.8 years to prevent one additional ear infection.[8]
Outcome[edit]
Tympanostomy 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 as the skin of the eardrum slowly migrates out towards the ear canal wall over time.[2] The eardrum usually closes without a residual hole at the tube site but in a small number of cases a perforation can persist. There is debate among clinicians as to whether long-lasting tubes are associated with a higher incidence of adverse outcomes, such as persistent perforation, cholesteatoma, tympanosclerosis and others, as opposed to tubes designed to last for shorter durations.[citation needed]
References[edit]
- ^ abcdefgVenekamp, Roderick P.; Javed, Faisal; van Dongen, Thijs Ma; Waddell, Angus; Schilder, Anne Gm (2016). 'Interventions for children with ear discharge occurring at least two weeks following grommet (ventilation tube) insertion'. The Cochrane Database of Systematic Reviews. 11: CD011684. doi:10.1002/14651858.CD011684.pub2. ISSN1469-493X. PMID27854381.
- ^ abcdefRosenfeld, Richard M.; Schwartz, Seth R.; Pynnonen, Melissa A.; Tunkel, David E.; Hussey, Heather M.; Fichera, Jeffrey S.; Grimes, Alison M.; Hackell, Jesse M.; Harrison, Melody F. (2013). 'Clinical practice guideline: Tympanostomy tubes in children'. Otolaryngology–Head and Neck Surgery. 149 (1 Suppl): S1–35. doi:10.1177/0194599813487302. ISSN1097-6817. PMID23818543.
- ^ abLieberthal, AS; Carroll, AE; Chonmaitree, T; Ganiats, TG; Hoberman, A; Jackson, MA; Joffe, MD; Miller, DT; Rosenfeld, RM; Sevilla, XD; Schwartz, RH; Thomas, PA; Tunkel, DE (March 2013). 'The diagnosis and management of acute otitis media'. Pediatrics. 131 (3): e964–99. doi:10.1542/peds.2012-3488. PMID23439909.
- ^ abcAmerican Academy of Otolaryngology–Head and Neck Surgery, 'Five Things Physicians and Patients Should Question', Choosing Wisely: an initiative of the ABIM Foundation, American Academy of Otolaryngology–Head and Neck Surgery, retrieved August 1, 2013, which cites
- Rosenfeld, R. M.; Schwartz, S. R.; Pynnonen, M. A.; Tunkel, D. E.; Hussey, H. M.; Fichera, J. S.; Grimes, A. M.; Hackell, J. M.; Harrison, M. F.; Haskell, H.; Haynes, D. S.; Kim, T. W.; Lafreniere, D. C.; LeBlanc, K.; Mackey, W. L.; Netterville, J. L.; Pipan, M. E.; Raol, N. P.; Schellhase, K. G. (2013). 'Clinical Practice Guideline: Tympanostomy Tubes in Children'. Otolaryngology–Head and Neck Surgery. 149 (1 Suppl): S1–S35. doi:10.1177/0194599813487302. ISSN0194-5998. PMID23818543.
- ^Syed, Mohammed Iqbal; Suller, Sharon; Browning, George G.; Akeroyd, Michael A. (2013). 'Interventions for the prevention of postoperative ear discharge after insertion of ventilation tubes (grommets) in children'. The Cochrane Database of Systematic Reviews (4): CD008512. doi:10.1002/14651858.CD008512.pub2. ISSN1469-493X. PMID23633358.
- ^Venekamp, Roderick P.; Mick, Paul; Schilder, Anne Gm; Nunez, Desmond A. (2018). 'Grommets (ventilation tubes) for recurrent acute otitis media in children'. The Cochrane Database of Systematic Reviews. 5: CD012017. doi:10.1002/14651858.CD012017.pub2. ISSN1469-493X. PMID29741289.
- ^National Deaf Children's Society- United Kingdom. 'Causes of glue ear | Information about glue ear'. www.ndcs.org.uk. Retrieved 2019-02-16.
- ^ abcMoualed, Daniel; Masterson, Liam; Kumar, Sanjiv; Donnelly, Neil (2016-01-27). 'Water precautions for prevention of infection in children with ventilation tubes (grommets)'. The Cochrane Database of Systematic Reviews (1): CD010375. doi:10.1002/14651858.CD010375.pub2. ISSN1469-493X. PMID26816299.
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![Placement Placement](/uploads/1/2/3/7/123717596/306521159.png)
OBJECTIVES: Determine the resorption rate and biocompatibility characteristics of 2 polyester ventilation tubes, and to determine whether soap and water exposure accelerates polyester tube degradation.
STUDY DESIGN AND SETTING: 50/50 poly (D, L-lactide-co-glycolide; PLGA-50) and poly (L-lactide; PLA) polymers were placed into the tympanic membranes of Hartley pigmented guinea pigs. Integrity of the tubes was determined by weekly otoscopic examination. Biocompatibility was assessed by comparing auditory brainstem response (ABR) thresholds and by examining tympanic membrane changes following tube resorption. Shah minigrommet ventilation tubes were used as controls. In the second portion of this study, implanted PLGA-50 and PLA tubes were exposed weekly to a mixture of soap and water (1:5) until complete resorption was observed. Biocompatibility was assessed by periodic ABR testing and tympanic membrane examination.
RESULTS: The PLA tubes remained in the tympanic membrane for a longer period (63.2 ± 19.3 days) than the PLGA-50 (18.8 ± 8.1 days). The tympanic membrane and resorbable tube interface demonstrated equivalent findings for auditory thresholds and tissue histopathology at the implant site compared to nonresorbable controls. The resorption behavior was not altered by exposure to soap and water. Tympanic membranes of all animals following tube degradation and soap water exposure were intact with minimal scarring and no signs of persistent foreign body response. The histological analysis showed that implantation of resorbable tubes was not accompanied by secondary infection with otorrhea through the tube, did not result in a permanent perforation or dislocation of the tube into the middle ear cavity, and was not followed by excess tympanosclerosis or localized or diffuse membrane atrophy.
CONCLUSIONS AND SIGNIFICANCE: Resorbable polyester pressure equalization tubes demonstrate predictable resorption behavior and similar bio-compatibility characteristics when compared with nonresorbable Shah minigrommet ventilation tubes. Exposure to soap water does not accelerate polyester tube degradation nor change the host tissue response during the indwelling period or after complete resorption. The data suggests that resorbable ventilation tubes are substantially equivalent to other FDA-approved tympanostomy devices with regard to safety and biocompatibility in the guinea pig model examined and may provide improved clinical performance by combining this approach with sustained release technology. EBM rating: B-2.
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