Middle ear ventilation tubes

Abstract

Twenty years have now passed since the first tube was placed through the tympanic membrane for middle ear ventilation. In this relatively short period of time, many different ideas for tube design have emerged and are presented. The types of middle ear fluid formation and the relationship of this formation to impaired eustachian tube function are discussed. The main indication for indwelling tubes is chronic secretory otitis media with effusion which fails to respond to conservative treatment; however, indications have been expanded with continued experience. The complications associated with the use of middle ear ventilation tubes are presented. Five years' experience using ventilation tubes in 1,460 ears is reported. Conclusions are based on data compiled from this study.

Factors Affecting the Extrusion Rates of Ventilation Tubes

“…The study started with 10 different types but supplies of 2 became difficult and these were therefore removed from the study. The types (Pappas 1974, Shah 1971) and numbers of each grommet inserted were Exmoor 142, Shepard 137, Bobbin 132, Arrow 58, Shah 131, Armstrong 138, Collar Button 141 and Paparella 60. The sister in charge of the operating theatre was given a list of the order in which the grommets were to be presented.…”

Long-term Paparella II grommet use in the management of persistent childhood otitis media: a 5-year follow-up study

“…Armstrong introduced the middle ear ventilation tube in 1954 and its use for the treatment of otitis media with effusion (OME) in children is widely practiced at present. Although about 70% of childhood OME resolves after a single intubation, recurrence (or persistence) of OME after spontaneous extrusion of the grommet remains a relatively common problem, often necessitating further grommets 1 …”

“…Paparella developed a long‐term silastic tympanostomy tube in the mid‐1960s 1 . The particular design features include a lateral flange tab (which aids removal if required), a medial flange notch (which helps insertion and is particularly useful in the atelectactic ear) and a large‐bore lumen to reduce the risk of blockage.…”

Audit of the incidence of persistent perforation of the tympanic membrane following grommet removal or extrusion

“…A total of 210 ears had tube insertions between the first of April 1987 and the thirty-first of March 1988. Of these 109 (51.9 per cent) were carried out as a second or further procedure; much higher than in other series, which ranged from 12.5-39 per cent (Mackinnon, 1971;Mawson and Fagan, 1972;Pappas, 1974;McLelland, 1980;Curley, 1986) (Table XI and Fig. 3).…”