OtoRhinoLaryngology Portal

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Myringotomy and Grommet

Grommet/Ventilation Tubes

First two from left are for short-term while the rest are for long-term purpose.

 

Grommet - Shephard type.  (red arrow - inner flange, blue arrow - outer flange, black arrow - the neck part which fits into myringotomy slit and stablize the grommet in place.

 

Figure shows the typical site of grommet and its orientation in right eardrum. 

Middle Ear Effusion: Suction of Tenacious Mucous

Arrow - tenacious mucous, TM - tympanic membrane, A - anterior, P - posterior, I - inferior, S - superior, (+) - lateral process of malleus, ST - suction tube.  Note: Patient in supine position under general anaesthesia.

 

Watch video of mucous suctioning after myringotomy @ YouTube

Middle Ear Effusion Drainage Immediately After Grommet Insertion

Yellowish mucous seen draining through ventilation tube channel.

OtoLAM Laser Myringotomy

Figure shows the result of OtoLAM laser myringotomy effect on dry paper.  Circular-shaped scanning laser beam was selected.  The sharpest image of the line (capillary on actual membrane) is the right focus required before the laser being triggered.  A clean-cut perforation was obtained as shown.

Pre-CO2 Laser Myringotomy of right tympanic membrane.

(Arrow - lateral process of malleus, S - superior, I - inferior, A - anterior, P - posterior).  NB: patient in supine position under general anaesthesia.

 

Helium-Neon target in view at its optimal focal distance - capillaries clearly seen. 

 

 The immediate view after tympanostomy made.  (X - middle ear effusion)

 

 Post-CO2 Laser Myringotomy of right tympanic membrane.

 (Arrow - lateral process of malleus, S - superior, I - inferior, A - anterior, P - posterior).  NB: patient in supine position under general anaesthesia. 

 

Watch video of OtoLAM Laser Myringotomy @ YouTube

 

Watch another video of CO2-laser myringotomy @ YouTube

Grommet/Ventilation Tube In-situ

Grommet or ventilation tube in a well-sited placement.  The middle ear effusion has resolved and eardrum is no longer retracted.  It will eventually extruded due to self--migratory property of the eardrum epithelium.

Well seen inner flange of grommet (yellow arrow) beyond a transparent eardrum.  White arrow - outer flange of grommet, red arrow - patent lumen of grommet enabling middle ear ventilation and pressure equalization on either side.

Grommet surrounded by dried secretion drained from middle ear space.  Myringosclerosis is evident around the grommet.

 

Watch video of grommet in-situ @ YouTube

Long-Term Ventilation Tube in the  Management of Chronic Eustachian Tube Dysfunction

 

Watch video of T-tube insertion @ YouTube

 

Further reading:

Raman R, Rahmat O. Branula used as T-tube introducer for middle ear effusion. J Laryngol Otol. 2008. Jun;122(6):635.

Self-Extrusion of Grommet/Ventilation Tube

 Extruded grommet at 2 o'clock position with normal looking eardrum at the background.

 

 Extruded grommet (asterisk) with retracted eardrum and recurrence of middle ear effusion.

 

Extruded grommet (asterisk) at anterior-inferior recess and granulation polyp adjacent to a minute perforation (arrow).  Ear discharge is obvious.

 

 

Grommet- Related Problems

       Epithelial crusts and blockage.        Earwax impaction surrounding grommet

                                                                 secondary to cotton-tip usage.

          Partially-inserted grommet                        Grommet surrounded by

      with visible inner flange superiorly.                       myringosclerosis.

Central scarring of a healed

eardrum post-grommet extrusion.

Migration of grommet into middle ear with closure of myringotomy opening.  Green hue of grommet seen beyond the eardrum (arrow) - green-coloured Shepard type grommet was used earlier.

 Recurrent ear discharge during upper respiratory tract infection or in situation likes untreated nasopharyngeal carcinoma and in chronic mastoiditis.

Otomycosis after bilateral myringotomy and grommet insertion.

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