Grommet Insertion Research Articles

Day-surgery in otology: Impact study of a dedicated organizational model

AimDay surgery (DS) in otology in France is insufficiently implemented compared to other countries of comparable socio-economic level. The aim of the present study was to evaluate changes in surgical practice in “major otology” cases in a hospital center after launching a dedicated ENT DS unit. Material and methodsThis new unit, designed in collaboration with the surgeons, was inaugurated in 2014. Number of procedures, patient demographics, surgery durations, and rates of crossover from DS to conventional management were recorded prospectively for the year before and the year after the launch. All otologic surgery procedures with at least tympanomeatal flap elevation were included; minor surgeries such as grommet insertion were excluded. ResultsBetween the two time periods, major otology day cases increased from 106 to 153 procedures (+43%). In 2013, the DS rate was 27%, versus 56% in 2015. Otosclerosis surgeries represented 7% in 2013 and 15% in 2015, and type II and III tympanoplasties 3% and 24% respectively. Difference in patient age between DS and conventional surgery was lower in 2015. Crossover rates were 10% in 2013 and 21% in 2015, mainly due to nausea/vertigo (56%) and surgery ending too late in the day (33%). ConclusionMajor otologic cases are suitable for DS. Launching this dedicated unit with its specific organization enabled a very significant increase in DS rates, probably due to greater patient satisfaction and surgeons’ growing confidence. The main pitfall was in scheduling, with surgery ending too late in the day for discharge home; this has since been corrected.

Menière's disease treated by grommet insertion.

Menière's disease (MD) is an uncommon cause of sudden profound vertigo. A variety of medical and surgical treatments have been used to manage this condition. This study reviewed the outcomes of patients treated with grommet insertion and transtympanic steroid injection. Patients diagnosed with MD between 2007 and 2017 were identified, and case notes and audiological data were retrieved for those managed by grommet (ventilation tube) insertion with and without transtympanic steroid injection. Thirty-three patients were identified as being diagnosed with MD. Grommet insertion resulted in cessation or improvement of attacks in 91% of cases. The mean follow-up duration was 33.8 months (median: 29 months). The mean hearing threshold across the low frequencies improved from 57.2dBHL to 49.4dBHL (p=0.031). Following the intervention, improved tinnitus was reported in 80% of cases. Twelve patients (36%) reported aural fullness prior to grommet insertion; all reported improved symptoms following the procedure. Early grommet insertion with transtympanic steroid injection, combined with customised vestibular physiotherapy, may provide an alternative first-line strategy for MD, preventing further true MD attacks. In some patients, it may significantly improve hearing thresholds.

Vestibular Dysfunction in Children Suffering from Otitis Media with Effusion: Does Grommet Help? An Observational Study Using Computerized Static Posturography.

Otitis media with effusion (OME) has a detrimental effect on balance, which may not present as a clear symptom in children. This effect can be improved by the insertion of ventilation tubes. This study assesses balance in children suffering from OME pre and post operatively using computerized static posturography. 50 children of 3-6years, suffering from OME were included in this observational descriptive study. These patients underwent myringotomy and grommet insertion. The balance was evaluated pre and post operatively after 3months using computerized static posturography with Modified Clinical Test of Sensory Interaction on Balance under four conditions, namely eyes open/closed on firm surface/foam. Posturography mean sway velocity was deranged in these children preoperatively and it showed statistically significant improvement post operatively at 3months. There is occult vestibular dysfunction in children with OME as assessed by static posturography which improves significantly 3months after myringotomy and grommet insertion.

Factors affecting the treatment outcomes of myringoplasty in patients with small tympanic membrane perforations.

Factors affecting the outcomes of myringoplasty have been widely discussed but remain controversial. In this study, we retrospectively analyzed the factors associated with the outcomes of myringoplasty treating small tympanic membrane perforations (defined as those involving less than 30% of the whole eardrum area) in patients with a history of chronic otitis media. The clinical demographic data, preoperative pure tone audiometry, surgical procedures, and surgical outcomes of patients with small tympanic perforations were analyzed statistically. Overlay myringoplasty was performed in 24 ears (45.27%); Gelfoam® plugs were placed in 29 ears (54.73%). Univariate and multivariate tests among demographic, surgical procedure-related, hearing test-related factors were performed. A total of 53 patients (22 males and 31 females) were enrolled (mean age 54.84 ± 15.51years). Fourteen patients (26.41%) had the habit of cigarette smoking, 8 (15.09%) had diabetes mellitus, 20 (37.73%) had a past history of chronic otitis media, 5 (9.43%) had a history of grommet insertion, 5 (9.43%) had received radiotherapy in the head and neck region, and 1 (1.88%) had microtia. The success rate for overlay myringoplasty using Silastic® sheets was 54.16%; the success rate for Gelfoam® plugs was 54.16%. On univariate analysis, smoking, older age, and the mean air conduction and bone conduction hearing levels significantly affected the surgical outcomes. Cigarette smoking was the only independent (negative) prognostic factor of surgical success on multivariate analysis (OR =0.1614, 95% CI: 0.0336-0.7762, p = 0.0228). As for surgical repair for the small tympanic membrane perforations with a history of chronic otitis media, age, cigarette smoking, mean air conduction threshold, and mean bone conduction threshold were associated with surgical outcomes; cigarette smoking was the independent predictive prognostic factor for the surgical outcomes.

Use of Phenol as a Local Anaesthetic for Adult Grommet Insertion in Resource-Limited Settings: A Preliminary Report.

Background Grommet insertion is one of the most commonly performed minor surgical procedures in otolaryngological practice. For such minor procedures in the outpatient, local anaesthetics are preferred; this is even more so in adults especially for grommet insertion. This study described our experience with the use of phenol as a local anaesthetic agent for grommet insertion in adults. Methods Phenol was used as a local anaesthetic agent that was applied topically for grommet insertion in adult patients as outpatient procedures between January and September 2018 in two tertiary hospitals. Data collected were analyzed using the Statistical Package for Social Sciences (SPSS IBM) version 23.0 computer software. Results Nineteen ear drums were operated in patients aged between 20 and 52 years. No pain or discomfort was reported by 89.5% and 94.7% had no bleeding. There was no vertigo in all the cases that completed the procedures. Conclusion This preliminary result shows that the use of phenol as a topical local anesthetic is simple, safe, and effective especially in resource-limited environments.

Precision Motion Control using Nonlinear Contact Force Model in a Surgical Device.

Otitis media with effusion (OME) is a common middle ear disease in children. The Ventilation Tube Applicator is an ear surgical device to treat OME by inserting a grommet into tympanic membrane (TM). This grommet insertion process requires very delicate control to minimise trauma to the TM and to ensure that the grommet is successfully inserted. This paper introduces a precision motion controller using Hunt-Crossley contact force model to provide a good prediction of the force on the TM during the insertion process. This predicted force was used to reject the disturbance in the motion control scheme and resulted in tremendous improvement in precision and accuracy. The maximum absolute tracking error of the motion controller was reduced by up to 29%, and the root mean square error was reduced by up to 43%. This novel use of a nonlinear contact force model has been proven to work well and can be considered for other robotic surgeries that involves contact and requires placement accuracy.

Management of secretory otitis media: a prospective randomised study comparing medical management with early surgical intervention

<p class="abstract"><strong>Background:</strong> Secretory otitis media is the most common cause of conductive hearing loss in children. Though self-limiting recurrent disease can cause speech and language delay, cognitive impairment and behavioural problems in the long term. This is a prospective study of the epidemiological profile, predisposing factors, clinical profile of secretory otitis media. This study also compares the conservative treatment with early surgical Treatment in Patient with secretory otitis media.</p><p class="abstract"><strong>Methods:</strong> The study is a prospective randomised study of patients presenting with conductive hearing loss diagnosed by pure tone audiometry. The patients were randomized into two groups of 25 patients each. The medical management arm received antihistamines and decongestants and the surgical arm patient underwent myringotomy with grommet insertion. Patients with adenoid hypertrophy underwent adenoidectomy as an additional procedure. The patients were followed up regularly and where evaluated at the end of 12 months for symptomatic improvement and hearing improvement by Pure Tone Audiogram and impedance audiogram. </p><p class="abstract"><strong>Results:</strong> The most common age group affected was between 5-15 yrs with hard of hearing and aural fullness being the most common presenting complaint. Eustachian tube dysfunction with adenoid hypertrophy was the most common precipitating factor (68%) followed by allergy and gastro esophageal reflux disease. Compared to medical treatment which resulted in a successful treatment outcome in 40% of patients, cases which underwent surgical treatment had successful outcome in 70% of cases.</p><p class="abstract"><strong>Conclusions:</strong> Surgical management in the form of adenoidectomy/myringotomy with grommet insertion has better long term outcome in terms of hearing impairment and disease relapse and recurrence.</p>

Aural fullness and transtympanic ventilation tubes in Ménière's disease: a scoping review.

Ménière's disease often presents with aural fullness, for reasons that are currently not well understood. Transtympanic ventilation tube insertion has been historically used for the management of this symptom, though the nature and mechanism of effectiveness is unclear. To give an overview of the data available on the effects of ventilation tube insertion on aural fullness in Ménière's disease. The databases PubMed, Embase, Medline, Scopus, Web of Science, Central and Google Scholar were searched to identify relevant records. Records were subsequently analysed and data extracted. Only two studies directly measured the effect of ventilation tube insertion on aural fullness, while three others measured it as a placebo to assess another treatment. Considerable heterogeneity was found amongst the studies, including conflicting conclusions. There is a paucity of evidence investigating the effect of grommet insertion on aural fullness in Ménière's disease. This work directs future research into this topic.

Optimization of the penetrative path during grommet insertion in a robotic ear surgery

The Ventilation Tube Applicator is an ear surgical device to treat otitis media with effusion by inserting a grommet into tympanic membrane (TM). This grommet insertion process requires very delicate control to minimise trauma to the TM and to ensure that the grommet is successfully inserted. This paper introduces a method to optimise the trajectory of the grommet insertion path by implementing neural network-based pattern classification, path planning algorithm, and precision motion control. A modified adaptive S-curve path was designed and optimised for four types of mock membranes. Experimental results showed that the pattern classification achieved 97% identification success, force on TM is reduced by up to 13%, TM deformation is decreased by up to 12%, and procedure’s success rate is improved by 100% for one type of mock membrane. The novel use of the Hunt–Crossley contact force model provided a good prediction of the force on the TM during the insertion process. This predicted force was used to reject the disturbance in the motion control scheme and resulted in tremendous improvement in precision and accuracy. The maximum absolute tracking error of the motion controller was reduced by up to 29%, and the root mean square error was reduced by up to 43%. This method has been proven to work well and can be considered for other surgeries requiring a penetrative motion and placement accuracy.

Adenoidectomy Before Or After Myringotomy In A Single Stage Procedure: Does The Sequence Matter?

Objective: To evaluate the sequence of performing adenoidectomy or myringotomy first in a single stage procedure has any bearing on the per- operative outcome on middle ear effusion and subsequent grommet insertion in a patient of otitis media with effusion (OME). The hypothesis was that initially performed adenoidectomy allowed the middle ear fluid to drain passively and precluded grommet insertion. Study Design and Setting: Comparative study conducted at Department of ENT, Combined Military Hospital Sialkot and PNS Shifa Hospital Karachi, from Jun 2016 to Jun 2017. Methodology: One hundred and twenty patients (218 ears) with OME and adenoid hypertrophy, meeting the inclusion criteria, were inducted in this study and divided into 2 groups. Group A (60 patients with 110 ears) had adenoidectomy first followed by myringotomy and or grommet insertion, while Group B (60 patients with 108 ears) had myringotomy with or without grommet insertion first and followed by adenoidectomy. Result: There were 76 males and 44 female patients with a ratio of 1.7:1 and the age range was 3 to 14 years with a mean age of 4.81 ± 0.77 years. There was a significant difference between the two groups. Out of a total of 110 ears in group A, 74 ears (67.2%) had no mucoid fluid or dry tap on myringotomy in contrast with group B where out of total 108 ears, only 26 ears (24.1%) had dry tap or no mucoid fluid (p = 0.001). Conclusion: Adenoidectomy performed before myringotomy significantly reduced the need for grommet insertion. Larger studies however are needed to corroborate these findings.

Quality of life in Swedish children receiving grommets – An analysis of pre- and postoperative results based on a national quality register

BackgroundOtitis media with effusion (OME) and recurrent otitis media (rAOM) are two common diagnoses in childhood, both of which are treated with grommets, or ventilation tubes. It is known that affected children have a worse quality of life (QoL), and various questionnaires have been used to evaluate this. The national Swedish quality register for grommet insertions contains some QoL questions that have hitherto never been analysed. MethodsData from 2010 to 2016 was extracted from the register and analysed with regards to QoL questions, reasons for surgery, hearing levels and number of AOM episodes. ResultsPreoperative QoL data was available for 3835 children. Before surgery, most parents felt that the QoL of their children was negatively affected by the ear disease. Parents of children with OME were more likely to suspect that their child had a hearing loss (ORs 10.1 and 28.2 for suspecting a mild and severe hearing loss, respectively), but less likely to find that the ear disease affected the child's general wellbeing than did parents of children with rAOM (ORs 0.54 and 0.33 for somewhat and much affected, respectively). Many children underwent surgery despite not fulfilling the criteria for surgery as stipulated in the national guidelines. Those who did fulfil criteria, however, had a more severely affected QoL. A significant improvement was seen in individual QoL scores after surgery (p < 0.001). The degree of postoperative improvement in pure tone average correlated with the improvement in QoL (p < 0.001). ConclusionThis is the first time that the QoL aspect has been analysed in the Swedish grommet register. Though the validity of the questions has not been proven, they provide valuable information. The relevance of the surgical criteria in national guidelines is illustrated by their correlation with the QoL questions, particularly for OME, and the postoperative improvement in QoL suggests parents find that their children benefit from surgery.

'Smart' grommets.

A novel, smartphone-based technique for endoscopic grommet insertion is presented.Results and conclusionThis method is both cost-effective and time-saving, offering a valuable alternative to the traditional microscope-based method in a resource-constrained setting.

The Goat Model for Exclusive Two Handed Endoscopic Middle Ear Surgery Training: A Novel Technique.

With the popularity of exclusive transcanal endoscopic ear surgery, the need for a suitable and affordable surgical training model has grown. To develop an ex vivo animal model for exclusive endoscopic ear surgery. In an experimental study, we studied goat middle ear anatomy in 8 specimens to assess the similarity with the human middle ear as a model for two handed endoscopic ear surgery with endoscope holders. After confirming its suitability, we have developed a surgical training program for grommet insertion, canaloplasty, myringoplasty, butterfly tympanoplasty, ossiculoplasty, atticotomy. The goat model is suitable for two handed endoscopic ear surgery using endoscope holder. We describe a novel, exclusively two handed endoscopic approach in an ex vivo animal model for middle ear surgery. The proposed surgical program will guide the trainee endoscopic ear surgeon for a step by step through the main otologic procedures to enhance his or her surgical skills.

Grommets in otitis media: a 25-year follow up

Background: This study is unique as it is the first study which can describe the long term sequelae of treatment of otitis media with effusion (OME) with insertion of grommets in the Primary Health Sector in Denmark.Objectives: Eardrum pathology and hearing acuity 25 years after treatment of OME by insertion of grommets, in a private ear-, nose-, and throat practice.Material and methods: 262 children with OME were treated from 1975 to 1978. The patients were re-examined by otomicroscopy, tympanometry and pure tone audiometry after 7.5, 12, and 25 years.Results: Hearing level, flaccida retraction and incudo pexi was equivalent. For atrophy and myringosclerosis no equivalence was shown using 95% confidence intervals. Tympanometry was fairly unchanged.Conclusion and significance: The insertion of a grommet in treating OME has no influence on hearing acuity in the long term. The prevalence of myringosclerosis and atrophy was unchanged in 70–80% of the eardrums. Most important is that the small increase in myringosclerosis and atrophy does not seem to influence the hearing acuity. We show that long term sequelae from the Primary Health Sector are similar to those from the Secondary Health sector.

Comparison of tympanocentesis, CO₂ laser tympanostomy and grommet insertion in the treatment for secretory otitis media in children

Objective:To compare adenoidectomy combined tympanocentesis, CO₂ laser tympanostomy and grommet insertion in the treatment for secretory otitis media (SOM) in children, and to provide basis for selection of surgical treatments. Method: Four hundred and twenty-six ears in 244 children with adenoid hypertrophy and SOM were divided into 3 groups which were: group A, 80 cases (142 ears) were treated with adenoidectomy combined with tympanocentesis; group B, 86 cases (145 ears) were treated with adenoidectomy combined with CO₂ laser tympanostomy; group C, 78 cases (139 ears) were treated with adenoidectomy combined with grommet insertion. Endotoscopy, tympanometry and PTA (or ABR) were conducted. Based on the characters of the middle ear effusion in operation, each ear were divided into two groups: Serous group and Mucus group. All patients conducted PTA (or ABR) 6 months after surgery and they were followed up until 1 year after surgery. The efficacy and postoperative complications and recurrence rate were compared among 3 groups, the prognosis of both serous group and mucus group were analyzed. Result:The effective rate of 3 groups at 6 months postoperative were 89.44%, 90.34% and 96.40% respectively, which showed no statistical difference among 3 groups and statistical difference between group C and group A, B was found. No statistical difference was found among 3 groups in serous group. The effective rate of group C was higher than that of group A and group B, with statistical difference. The rate of postoperative complications (permanent tympanic membrane perforation, middle ear infection postoperative, tympanic tube blockage or detachment, etc.) during 1 year postoperative in 3 groups were: 16.20%, 13.10%, 33.81%, respectively. The recurrence rates were: 11.02%, 12.98%, 3.73%, respectively, and the reoperation rate in all 3 groups were 0. Conclusion:In the treatment for SOM in children with adenoid hypertrophy, adenoidectomy combined with tympanocentesis or combined with CO₂ laser tympanostomy showed a similar effects, which was slightly lower than adenoidectomy combined with gromment insertion. Considering the complications postoperative and recurrence rates of different operations, tympanocentesis or CO₂ laser tympanostomy is recommended to be conducted as routine, and grommet insertion is recommended to be conducted when mucus-like middle ear effusion is found during surgery.

What matters most when it comes to vocabulary and language development?

What matters most when it comes to vocabulary and language development?

Streamlining grommet pathways for otitis media with effusion and hearing loss in children: our experience.

Grommet insertion is a common surgical procedure in children. Long waiting times for grommet insertion are not unusual. This project aimed to streamline the process by introducing a pathway for audiologists to directly schedule children meeting National Institute for Health and Care Excellence Clinical Guideline 60 ('CG60') for grommet insertion.Method and resultsA period from June to November 2014 was retrospectively audited. Mean duration between the first audiology appointment and grommet insertion was 294.5 days (median = 310 days). Implementing the direct-listing pathway reduced the duration between first audiology appointment and grommet insertion (mean = 232 days; median = 231 days). There has been a reduction in the time between the first audiology appointment and surgery (mean difference of 62.5 days; p = 0.024), and a reduction in the time between second audiology appointment and surgery (28 days; p = 0.009). Direct-listing pathways for grommet insertion can reduce waiting times and expedite surgery. Implementation involves a simple alteration of current practice, adhering to National Institute for Health and Care Excellence Clinical Guideline 60. The ultimate decision regarding surgery still rests with ENT specialists.

Novel Design and Validation of a Micro Instrument in an Ear Grommet Insertion Device

An automated surgical device, the ventilator tube applicator (VTA), enables a grommet insertion surgery for patients with otitis media with effusion (OME) to be completed in a short time automatically and precisely, eliminating the use of general anesthesia (GA) typically required in such procedure. However, its current design limits the usefulness of the device as it is restricted by the properties of the tympanic membrane (TM), such as angle, thickness, and strength. Therefore, a novel design was conceptualized and the insertion control algorithm was improved to overcome the current challenges of the VTA. This innovative cover-cutter instrument design allows three-dimensional (3D) motion on an oblique surface using a single axis actuator. Experimental results on mock membranes showed great improvements in terms of robustness and success rate. The new design allowed the procedure to be performed on wider range of TM angles and hence increased the effectiveness of VTA. Grommet insertion force was reduced by an average of 66%, and the overall peak force reduced by an average of 14%. Finite element (FE) analysis on a cadaveric TM model further validated the usefulness of the cover-cutter instrument, and showed some interesting insights in the grommet insertion process.

Medial migration of grommet: Iatrogenic foreign body.

Myringotomy and grommet insertion is a common surgical procedure in paediatric. It is relatively simple and safe procedure but few complications has been documented. We presented here a case of migration of grommet ventilation tube into the medial ear which is a very rare complication.Bangladesh Journal of Medical Science Vol.17(3) 2018 p.493-495

Diagnosis and management of conductive hearing loss in children with trisomy 21.

The objective of this study is to review the prevalence and degree of hearing loss in children with trisomy 21, their response to intervention and the presence of concomitant pathologies. The project will also highlight the experiences of the children from their parents' and guardians' perspective and the link between perceived service quality and an objective improvement in their hearing after rehabilitation. All patients with trisomy 21 who were referred to district general otolaryngology outpatient clinics between 2014 and 2016 were included. A retrospective analysis of the medical notes and audiograms along with a qualitative questionnaire to the children's parents was utilised to gather the information. The study showed that 77% (17/22) of children suffered from hearing loss, with a moderate degree being most prevalent. The majority of patients (14/17, 82%) were managed conservatively, undergoing a period of watchful waiting (9/17, 53%) or receiving hearing aids (5/17, 30%) and 3 of 17 (17%) were managed with grommet insertion. The improvement in hearing with hearing aids was comparable with grommet insertion and hearing aids scored highest in the post-intervention qualitative assessment with grommet insertion scoring the lowest. Functional hearing has been shown to be key in developing speech and language skills. In children with trisomy 21, behavioural and anatomical abnormalities make the diagnosis and intervention technically more challenging. This study demonstrates that in the absence of other otological symptoms, hearing loss can be managed effectively and with the least distress to the children with hearing aids.