Grommets

Grommets are small tube like objects made of plastic or titanium. It is also called ventilation or tympanostomy tubes. It is surgically inserted into the eardrum (tympanic membrane) of a patient.

The main purpose is to establish a semi permanent or permanent communication between the middle ear and the outside world. When this happens air can travel without restriction in and out of the middle ear, preventing unnecessary pressure changes in the middle ear.

In normal patients the Eustachian tube controls the pressure in the middle ear. When the Eustachian tube, however, does not function properly the changes of ear pressure in the middle may create problems. Hearing loss, build up of fluid (glue ear) and middle ear infections (otitis media) are complications of Eustachian tube dysfunction, which may be prevented or reversed by placing grommets.

After making a small hole in the eardrum, fluid in the middle ear can be drained if necessary. The grommet is then placed. Grommets are usually temporary and extrude after some time and the hole (perforation) in the eardrum closes by itself. Sometimes they need to be removed. Some grommets are designed to stay permanently in the ear (T-tubes).

Grommets are routinely inserted under general anesthesia, especially in children. It can also be placed under a topical anesthetic.

It is also indicated in some patients with Meniere’s disease (MD), where it helps to regulate pressure and create a pathway for administrating medication. Intratympanic steroid administration through a grommet is used in autoimmune inner ear disease (AIED) and sudden sensorineural hearing loss (SSNHL). It is also placed before hyperbaric treatment to prevent pain and a burst eardrum during compression.

Unfortunately grommets are not without risk. Water should be kept from ears after insertion. In some cases the hole in the eardrum does not close after extrusion of the grommet and surgical repair may be required (meatoplasty). Other possible complications should be discussed before placement.