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surgical incision into the eardrum (to relieve pressure or release pus from the middle ear)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/04/24 14:27:35」(JST)

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The grommet is less than 2 mm tall, smaller than a match head.

Tubes of a more permanent style, unlike those typically used in the United States. These tubes remained in place for four years until one spontaneously left the ear drum. The other was removed with tweezers after having partially disengaged from the ear drum. The removal process can cause significant pain for several minutes.

A tympanostomy tube (also known as a grommet, T-tube, ear tube, pressure equalization tube, vent, PE tube or myringotomy tube) is a small tube inserted into the eardrum in order to keep the middle ear aerated for a prolonged period of time, and to prevent the accumulation of fluid in the middle ear. The operation to insert the tube involves a myringotomy and is performed under local or general anesthesia. The tube itself is made in a variety of designs. The most commonly used type is shaped like a grommet. When it is necessary to keep the middle ear ventilated for a very long period, a "T"-shaped tube may be used, as these "T-tubes" can stay in place for 2-4 years. Materials used to construct the tube are most often plastics such as silicone or Teflon. Stainless steel tubes exist, but are no longer in frequent use.

Although myringotomy with tube insertion can be performed under local anesthesia during a regular doctor's appointment in co-operative adults, patients requiring tube insertion are very often young children. Since damage to the ear is possible unless the patient stays quite still while being manipulated, any patient who may have difficulty lying still during the procedure undergoes myringotomy and tube insertion under general anesthesia.

The insertion of tympanostomy tubes is one of the most common surgical procedures performed on children. In the USA, it is the most common reason for a child to undergo a general anaesthetic.^[1]

Tympanostomy tubes generally remain in the eardrum for six months to two years, with T-tubes lasting up to four years. They generally spontaneously fall out of the eardrum as the skin of the eardrum slowly migrates out towards the ear canal wall over time. The eardrum usually closes without a residual hole at the tube site but in a small number of cases a perforation can persist.

Long term studies have called the necessity of routine ear tube surgery into question,^[2]^[3] but current guidelines for American otolaryngologists indicate tube placement in the following conditions:

Chronic otitis media with persistent effusion for 6 months (one ear) or 3 months (both ears).
Recurrent acute otitis media: 3 ear infections in 6 months or 4 infections in a year.
Persistent eustachian tube dysfunction
Barotrauma: Especially for prevention of recurrent episodes (e.g., after air travel, hypobaric chamber treatment).

References

^ Vaile L. Williamson T. Waddell A. Taylor G. Interventions for ear discharge associated with grommets (ventilation tubes)
^ [1]
^ [2]

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UpToDate Contents

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1. 小児に対する中耳腔換気用チューブ留置、術後ケア、および合併症の概要 overview of tympanostomy tube placement postoperative care and complications in children
2. 小児における中耳腔換気用チューブ留置後の耳漏：原因、予防、およびマネージメント tympanostomy tube otorrhea in children causes prevention and management
3. 小児における急性中耳炎：再発予防 acute otitis media in children prevention of recurrence
4. 小児における滲出性（漿液性）中耳炎：マネージメント otitis media with effusion serous otitis media in children management
5. 成人における急性中耳炎（化膿性および漿液性） acute otitis media in adults suppurative and serous

English Journal

Prevalence of ventilation tubes in children with a tracheostomy tube.

McAfee JS, Demarcantonio M, Fine BR, Beydoun H, Derkay CS.SourceDepartment of Otolaryngology, Eastern Virginia Medical School, Norfolk, VA, United States.
International journal of pediatric otorhinolaryngology.Int J Pediatr Otorhinolaryngol.2013 Jan;77(1):65-8. doi: 10.1016/j.ijporl.2012.09.031. Epub 2012 Nov 3.
OBJECTIVES: To estimate the prevalence of operative ear disease in pediatric patients with tracheostomy tubes, as well as to identify risk factors predictive of operative otologic interventions in this patient cohort.METHODS: We hypothesize that the prevalence of operative middle ear disease in pati
PMID 23131201

What is the role of tympanostomy tubes in the treatment of recurrent acute otitis media?

Whittemore KR Jr.SourceDepartment of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston; and Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.. kenneth.whittemore@childrens.harvard.edu.
The Laryngoscope.Laryngoscope.2013 Jan;123(1):9-10. doi: 10.1002/lary.23601.
PMID 23280939

Ototopic applications of povidone iodine/dexamethasone in the rat.

Pawlowski K, Koulich E, Wright CG, Roland P.Source*Department of Otolaryngology-Head and Neck Surgery/Biomedical Engineering, and †Department of Otolaryngology- Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, U.S.A.
Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.Otol Neurotol.2013 Jan;34(1):167-74. doi: 10.1097/MAO.0b013e31827a21a2.
HYPOTHESIS: Repeated applications of low-concentration povidone iodine (PI) combined with dexamethasone (Dex) through a tympanic membrane ventilation tube will not cause ototoxic changes in the rat.BACKGROUND: Otitis externa (OE) and acute otitis media (AOM) are 2 of the most common otologic disorde
PMID 23202157

Japanese Journal

A Case of Extranodal Non-Hodgkin's Lymphoma in which Otitis Media with Effusion and Combined Hearing Loss Developed as the Initial Symptoms

Maruyama Yumiko,Tsukada Yayoi,Kasahara Yoshiya,Yoshizaki Tomokazu
耳鼻咽喉科臨床　補冊 141(0), 18-19, 2015
… Since conservative treatment was not effective, a tympanostomy tube was inserted. …
NAID 130005077979

滲出性中耳炎で発症したANCA陽性の難治性中耳炎の3例

生駒亮,坂根さやか,長岡章平,井畑淳,折舘伸彦
Otology Japan 24(2), 106-112, 2014
滲出性中耳炎で発症したANCA陽性の難治性中耳炎の3症例を経験した。3症例とも滲出性中耳炎に対する鼓膜切開術や鼓膜チューブ留置術で奏功せず、経過中にMPO-ANCAが陽性となった。2例は原渕らによるANCA関連血管炎性中耳炎 (Otitis media with ANCA-associated vasculitis: OMAAV) の診断基準 (案)(表1)1)における確実例であった。1例は結節性 …
NAID 130005085319

A Study on Ventilation Tube Therapy for Chronic Otitis Media with Effusion in Children

Yamano Takafumi,Sakata Toshifumi,Nakagawa Takashi
耳鼻咽喉科臨床　補冊 140(0), 18-19, 2014
… for chronic otitis media with effusion in children, to investigate how the incidences of recurrence and tympanic membrane perforation varied with duration of placement, and to determine the most appropriate duration of placement.Methods: Using a questionnaire survey in clinics after follow-up, we studied 119 ears 74 children with chronic otitis media with effusion, undergoing ventilation tube therapy between January 2007 and December 2012.Results: The duration of tympanostomy tube placement was 444 days on average, and recurrence was seen in 5 …
NAID 130004707420