Evidence note 22
The clinical and cost effectiveness of surgical insertion of
grommets for otitis media with effusion (glue ear) in children
Background
Grommets (ventilation or tympanostomy tubes) are small plastic
or metallic tubes that are inserted through the tympanic membrane
(eardrum) following myringotomy, a procedure that involves creating
a hole in the eardrum and draining fluid in the middle ear. The
rationale for grommet insertion is to prevent fluid accumulation
and to help pressure regulation in the middle ear.
The operation lasts approximately 20 minutes. It can be done
under local anaesthetic although more often it is carried out under
general anaesthetic as the patients are predominantly young
children. Once inserted, grommets stay in place for typically 6 to
12 months before eventually being ejected as the eardrum heals
naturally. About 20-50% of children may require re-insertion of
grommets after tube extrusion due to relapse of otitis media with
effusion (OME ¿ see ¿Epidemiology¿ section below)
The insertion of grommets can be carried out in conjunction with
surgical removal of adenoid glands (adenoidectomy) or occasionally
tonsils (tonsillectomy). The aim of combining procedures is to
reduce subsequent upper respiratory infections, which are
frequently associated with OME.
Key points
- Otitis media with effusion (OME) is common in children. Most
cases resolve spontaneously. Persistent, bilateral hearing loss is
the major concern for OME.
- There is good evidence that surgical insertion of grommets
provides short-term benefit in correcting hearing loss associated
with OME. The benefit diminishes with time.
- Adjunct adenoidectomy provides a small additional benefit in
hearing. Evidence is insufficient to ascertain possible long-term
benefits of adjunct adenoidectomy combined with grommet
insertion.
- Good quality, long-term trials have demonstrated that watchful
waiting (delayed insertion of grommets if OME remains unresolved)
compared to immediate insertion of grommets does not result in
disadvantage in language, behaviour or social development for
children with persistent bilateral OME diagnosed under 3 years old
who do not otherwise have disabling conditions.
- It is uncertain whether the safe use of watchful waiting is
generalisable to older children and children who have already shown
disruptions in language and behaviour development at
diagnosis.
- Limited, preliminary evidence suggests that surgical insertion
of grommets without adenoidectomy may be cost-effective compared to
doing nothing after 3 months of watchful waiting.
Published Date: 1 January 2008
