How to solve persistent deafness due to serous otitis by ENT microsurgery (grommet).
How can one recognise serous otitis?
Serious otitis is a chronic inflammatory condition of the middle ear due to the presence of a yellow and glutinous serous fluid behind the eardrum. This condition is the result of a lack of prolonged aeration of the middle ear due to a block in the Eustachian tube whose role is to send air into the ear when we swallow our saliva: the longer the absence of aeration, the more the hearing loss will be important.
Serous otitis is very common in children between 1 and 6/8, with a peak at 4 years: about one out of two children had serous otitis at the age of 1. Obstructive hypertrophy of the adenoids, which are located behind the nasal cavities and prevent the Eustachian tubes from functioning well, is the major cause of serous otitis. A true nest of microbes, the community (nursery/school) aggravates the phenomenon. Serous otitis is rarer in adults and is usually associated with chronic or acute respiratory infections.
Diagnosis of serous otitis
Serous otitis is not very painful in children but can cause conductive deafness and eventually a negative impact on the communication and development of the child. A language delay or behavioural problems (inattention, aggressiveness) are signals that should lead the entourage to consult a ENT head and neck surgeon.
In adults, the pain will be stronger with a clogged ear sensation accompanied by a paradoxical impression of resonance in the head, sometimes accompanied by pain.
Grommet or tympanostomy tube surgery (TTs)
A large majority of serous otitis heals spontaneously after 3 months following medical treatments (anti-inflammatory, anti-allergen and decongestant). However, 5 to 10% persist beyond that, and the installation of a transtympanic tube "grommet", associated with the ablation of adenoids, is the only effective solution to improve hearing almost instantaneously.
The grommets or tympanostomy tube (TTs) are tiny hollow plastic tubes placed in front line treatment with the help of a microscope through the tympanic membrane and used to ventilate the middle ear. The “grommets” (TTs) placed in second line have the shape of T (T-tubes).
This procedure, lasting about 10 minutes for both ears under general anaesthesia in the operating room, is performed in outpatient surgery (day hospital). The length of stay is 4 to 5 hours.
Benefits of Grommets (TTs)
The indications for a grommet insertion are:
Repeated serous otitis for more than 4 months complicated by deafness greater than 25/30 DB
Acute otitis accompanied by persistent effusion previously treated with antibiotics
Fibro-adhesive otitis causing permanent hearing problems
• Moderate, short-term pain
• Generic antibiotics for 1 week
• Check-up the 1st month after surgery, then every 4 months.
As in any surgical intervention, there are risks of complications, including perforation of the eardrum, fall of the drain in the eardrum, trauma, ear flow, which may require a subsequent surgical recovery.
What are the restrictions following the surgery?
Water diving is not recommended. On the other hand, it is possible to swim, provided the external auditory canals are protected against the penetration of water, with the help of earplugs and/or adapted headbands.
When can the “grommets” (TTs) be removed?
TTs placed at the start are spontaneously expelled in 6 to 12 months, the eardrum will close behind them. T-tubes placed in second line must be extracted under general anaesthesia by the ENT surgeon, who can at the same time close the perforation with a fat graft.
Coverage of tympanostomy tube surgery by social security
This surgery is covered by social security, but your head and neck ENT surgeon may request an additional fee.
Dr. Stéphane Hervé is an ENT specialist and head and neck surgeon who graduated from some of the best universities in France. He combines the precision of a refined ENT microsurgery technique with the technological innovation of the ZEISS OPMI VARIO 700 operating microscope.