The History of Myringotomy and Grommets

Perioperative and postoperative management of tympanostomy tube insertion: a survey of otorhinolaryngologists in Israel

BACKGROUND

Tympanostomy tube insertion is a standard surgical procedure in children to address middle ear infections and effusion-related hearing and speech development issues. Perioperative treatments like ear drops containing antibiotics, steroids, and tube irrigation with saline aim to prevent complications, yet no universal gold standard treatment exists. Despite guidelines, practice preferences among ENT specialists vary, motivating this study to investigate perioperative management practices in Israel.

METHOD

A survey was distributed among ENT surgeons, collecting data on their main workplace, sub-specialty, preoperative hearing test requirements, tube irrigation practices, tube selection criteria, and timing of tube removal. Distribution and association with main workplaces were examined.

RESULTS

The survey achieved a response rate of 27.33%. Most participants routinely required preoperative hearing tests, with a preference for conducting them within three months prior to surgery (62.2%). Tube irrigation during the procedure was less common among surgeons in the public system (p = 0.007). In response to the COVID-19 pandemic, the majority of respondents maintained their established practices (96.3%), while a small proportion (3.7%) adapted by replacing two in-person meetings with one virtual session. Variations in tube removal timing based on the main workplace were noted, with private practitioners opting for earlier removal (p = 0.002) and were less permissive in water deprivation practices (p = 0.053).

CONCLUSION

This study provides insights into the practices and preferences of ENT surgeons in tympanostomy tube insertion procedures in Israel. Adherence to standardized practices was observed, with variations influenced by the primary workplace. Despite the COVID-19 pandemic, minimal changes were made to established practices. Further research and consensus are necessary to optimize patient outcomes and develop tailored guidelines in this field.

Endoscopic Treatment of Otitis Media with Effusion

Myringotomy with grommet insertion is considered the standard of care for patients with unresolved otitis media with effusion and is traditionally performed under the operating microscope. The introduction of endoscopic ear surgery has provided otologists a tool for minimally invasive ear surgery with a panoramic view. We have described the use of endoscope for myringotomy and grommet insertion. The technique was found to be safe and effective and has the added advantage of being an excellent tool for teaching. The advantages and disadvantages of this technique vis a vis the traditional otomicroscopic technique have been discussed.

An Overview of the Tympanostomy Tube

Otitis media is a disorder of the middle ear, which can occur at any age but is more common among infants and children. The patient usually presents with earaches, impaired hearing, and fever. If antibiotics and decongestants do not suit the patient, a myringotomy can be performed to achieve middle ear aeration. In myringotomy, a slit is created in the tympanic membrane, and fluid is removed with suction. In cases where myringotomy, aspiration, and medical care don't help and the fluid recurs, a tympanostomy tube is inserted to create continuous aeration of the middle ear. A tympanostomy tube is a small tube inserted in the tympanic membrane which helps in the prevention of fluid accumulation in the middle ear. These tubes are temporary and often fall off after the ear heals. Other names for tympanostomy tubes are grommet, myringotomy tube, or pressure equalizing tube. Initially, tympanostomy tubes were made of metal but now fluoroplastic or silicone elastomers are used to make them. The two basic designs of a tympanostomy tube are short-term tube and long-term tube. The choice of a tympanostomy tube depends on factors like age, the period needed for ventilation, socioeconomic status, and the extent of the retracted eardrum. The incidence of occlusion, infection, functional duration, and persistent perforation following extrusion varies between the designs and materials. Every year, many children are affected by recurrent otitis media, which can negatively influence their quality of life and their ability to hear and communicate. With so many children requiring tympanostomy tubes, choosing the appropriate tube is vital to provide optimal treatment and limit complications.

Postero-superior tube in a grooved bone vs. transtympanic tube for middle ear ventilation: a retrospective study comparing outcomes in the Lebanese pediatric population

BACKGROUND

Myringotomy with trans-tympanic T-tube (TTT) placement is the most common surgical procedure performed in children. Finding a technique that provides longer aeration periods, lower complications rates, and less need for subsequent interventions will help the healthcare system from preventable events.

OBJECTIVES

To compare the efficiency and complications rates of the traditional TTT to those of the novel postero-superior tubes in a grooved bone (TGB) for long-term middle ear ventilation in children suffering from recurrent acute otitis media (RAOM), or chronic otitis media with effusion (COME).

METHODS

A total of 200 pretreated ears (96 by TGB and 104 by TTT), were examined after at least 3 years. Data concerning tube condition, and ear outcomes were collected. Pre- and post-operative audiograms were also performed.

RESULTS

TGB remained in place for longer periods, and it resulted in significantly lower rates of persistent tympanic membrane (TM) perforation (0% vs. 30.8%), TM retraction (14.6% vs. 32.7%), myringosclerosis (12.5% vs. 38.4%), otorrhea (29.2% vs. 52.9%), and need for topical antibiotics (31.3% vs. 51%). It has also resulted in more significant reduction in the air-bone gap on audiograms.

CONCLUSIONS AND SIGNIFICANCE

TGB could be an effective and safe option for middle ear ventilation following COME or RAOM in children.

History of Myringotomy and Grommets: A Perpetuation of Inaccuracies?

This letter discuss the inaccuracies contained in the recent paper about history of myringotomy and grommets.