Tympanostomy tube

Tympanostomy tube, also known as a grommet, myringotomy tube, or pressure equalizing tube, is a small tube inserted into the eardrum via a surgical procedure called myringotomy to keep the middle ear aerated for a prolonged period of time, typically to prevent accumulation of fluid in the middle ear.

The tube itself is made in a variety of designs, most often shaped like a grommet for short-term use, or with long flanges and sometimes resembling a T-shape for long-term use. Materials used to manufacture the tubes are often made from fluoroplastic or silicone, which have largely replaced the use of metal tubes made from stainless steel, titanium, or gold.

Inserting tympanostomy tubes is one of the most common pediatric surgical procedures in the United States, with 9% of children having had tubes placed sometime in their lives. Tympanostomy tubes are typically placed in one or both eardrums to help children suffering from recurrent acute otitis media (ear infection) or persistent otitis media with effusion (sometimes called "glue ear").

Tympanostomy tubes work by improving drainage, allowing air to circulate in the middle ear, and offering a direct route for antibiotics to enter the middle ear. Tube placement has been shown to increase hearing in children with persistent otitis media with effusion and may lead to fewer ear infections for children with frequent ear infections. Once placed, short-term tubes are designed to stay in the eardrum for 6–15 months, whereas long-term tubes are designed to stay for 15–18 months. Tympanostomy tubes usually fall out on their own as the eardrum heals over time; however, they can sometimes get stuck in the eardrum and require surgical assistance for removal.

Guidelines state that tubes are an option in:

While tympanostomy tubes are commonly used in children, they are seldom used in adults. Options for use in adults include:

Otorrhea (ear discharge) is the most common complication of tympanostomy tube placement, affecting between 25–75% of children receiving this procedure. Saline washouts and antibiotic drops at the time of surgery are effective measures to reduce rates of otorrhea, which is why antibiotic ear drops are not routinely prescribed. If children experience persistent ear drainage or have new discharge two weeks following surgery, antibiotic ear drops are an effective treatment and have been shown to work better than oral antibiotics. Frequent use of ear drops in children may have an ototoxic effect, which is why antibiotic ear drop use following surgery should only be recommended by a trained healthcare professional.

Potential risks of tympanostomy tube placement in children include going under general anesthesia to have the procedure as well as adverse effects following tube placement. Estimates of these other adverse effects from tubes being in the eardrum include: