Grommet / Tympanostomy tube / Ventilation tube

🦻 Ventilation tubes / Grommet / Tympanostomy tubes

🔩 What is a Ventilation Tube?

A ventilation tube is a small hollow prosthetic tube, open at both ends, inserted through a surgically created myringotomy in the tympanic membrane.

📌 Synonyms

• Grommet
• Tympanostomy tube
• Pressure Equalizing (PE) tube

➡️ It substitutes the pressure-equalizing function of the Eustachian tube.

What is the Purpose of Ventilation Tubes?

🧪 Materials Used in Ventilation tubes

Commonly used materials:

• Teflon (most common)
• Silastic (silicone)
• Stainless steel
• Titanium
• Gold
• Polyethylene (less preferred)

🧬 Newer Tubes

• Bioabsorbable / bacteriostatic grommets
• Made of polylactic acid

What coating is given to ventilation tubes to avoid biofilm formation?

⭐ Features of an Ideal Ventilation Tube

1. Biocompatibility

2. Chemical Stability

3. Mechanical Strength

4. Non adhesive Surface

5. Adequate Ventilation

6. Sterilizability

Explain each of the features of an Ideal Ventilation Tube.

🔄 Types of Ventilation Tubes

Based on duration of retention, ventilation tubes are classified into:

• Short term grommets
• Long term grommets

⏳ Short Term Grommets

📌 Duration

• Retained for 6-12 months
• Spontaneous extrusion
• No manual removal required

What are the Indications of using Short term grommet?

📌 Materials

• Teflon
• Silicone
• Polyethylene

📌 Features

• Small and lightweight
• Easily extruded by epithelial migration
• Low risk of persistent perforation

Give examples of Short Term Grommets, and describe each one of them.

🕰️ Long Term Grommets

📌 Duration

• Retained for 12–24 months or longer
• Often require manual removal

What are the Indications of using Long term grommet?

📌 Materials

• Silicone
• Teflon
• Titanium

📌 Features

• Larger lumen (better long term patency)
• Wider inner flange (prevents extrusion)
• Higher risk of permanent TM perforation

Give examples of Long Term Grommets, and describe each one of them.

✅ Indications of Grommet Insertion

• Otitis Media with Effusion (OME) – Primary Indication

What are the indications of Myringotomy and Grommet Insertion in Otitis Media with Effusion (OME)?

• Recurrent Acute Otitis Media

What is Recurrent Acute Otitis Media?

📘 In my detailed notes, I’ve discussed an exhaustive list of Intraindications of Myringotomy and Grommet Insertion.

🚫 Contraindications of Grommet Insertion

❗ Absolute Contraindications

• Only hearing ear
• Intra tympanic glomus tumor

⚠️ Relative Contraindications

• Acute otitis externa
• Atrophic tympanic membrane

📘 In my detailed notes, I’ve discussed an exhaustive list of Absolute and Relative Contraindications of Myringotomy and Grommet Insertion.

⚠️ Complications of Grommet Insertion

🛠️ Intra operative

• Bleeding
• Tube displacement into middle ear
• Ossicular injury

⏱️ Early Post operative

• Otorrhea (most common)

🕰️ Late Post operative

• Persistent TM perforation

📘 In my detailed notes, I’ve discussed an exhaustive list of Complications of Grommet Insertion.

📌 Viva Pearls

• Most common tube: Shepherd grommet
• Type B tympanogram in OME
• Posteriorsuperior quadrant is avoided
• Long-term tubes ↑ risk of permanent perforation
• Unilateral OME in adults → rule out NPC