Description
Case I
Case II
Case III


Description 

Ventilation tubes (grommets) are surgically inserted into the tympanic membrane to ensure proper ventilation of the middle ear in chronic otitis media with effusion when other methods are not effective. Ventilation tubes also allow to stabilize the weakened eardrum. There are many types of ventilation tubes. They can be divided into two main groups – these assumed for a short period that fall out spontaneously and worn over a longer period of several years, which are usually removed surgically.


Case I

Picture below: this is a picture of ventilation tube that was inserted into the tympanic membrane in the right ear of the child with chronic otitis media with effusion. This tube consists of polytetrafluoroethylene and has a small diameter (approx. 1 mm). It is set in the extension of the handle of malleus. After a period of a few to several months, the tube gradually moves towards the periphery of the eardrum eventually falling out into the lumen of the external auditory canal, from where it can be easily removed. The time the tube remains in the eardrum allows the healing of the middle ear. Very often inserting of the tube is carried out with adenoid surgery. In children this procedure is performed under general anesthesia, while in adults it can be done after local anesthesia of the tympanic membrane (fig. 1).

Tympanic cavity drainage
Fig. 1 Tympanic cavity drainage

Case II

This is a picture of ventilation tube that was inserted into the tympanic membrane in the left ear of the child with chronic otitis media with effusion. The tube has two flanges – external (visible in the picture) and internal (hidden in the tympanic cavity) of greater diameter so that it can persist for several years. It is set in the extension of the handle of malleus. The time the tube remains in the eardrum allows the healing of the middle ear. Such a procedure is performed in recurrent otitis media with effusion and with destruction of the tympanic membrane, and in situations where previously smaller tubes were inserted but they were non effective. In children this procedure is performed under general anesthesia, while in adults it can be done after local anesthesia of the tympanic membrane. After a period of several years, if there is no inflammation the tube can be removed by performing a single stage operation with myringoplasty, as this tube leaves a perforation (fig. 2).

Tympanic cavity drainage
Fig. 2 Tympanic cavity drainage

Case III

The picture shows the state after myringotomy, right ear, 7-year-old child. Immediately after myringotomy the secretion from the middle ear escaped into the lumen of external auditory canal being under high pressure in the middle ear. Secretion is cloudy, has a thick consistency, amber color. After removing the discharge with the suction, ventilation tube was inserted into the tympanic membrane to ensure proper ventilation of the middle ear. Tympanic membrane has also deposits of tympanosclerosis: whitish patches on the tympanic membrane that form kind of hard layer, which mobility is restricted, in particular in the posterior quadrant but also in the rest of the tympanic membrane at its edges.  The child reported constant fullness and pain of this ear. She was treated for several years for recurrent chronic otitis media with effusion (fig. 3).

Ear after myringotomy
Fig. 3 Ear after myringotomy