Introduction: The organisms that cause many device-related and other chronic infections actually grow in biofilms in or on these devices. We sought to examine the role of biofilm formation in chronic middle-ear ventilation tube infection.

Case report: Scanning electron micrograph images are presented which demonstrate biofilm on a middle-ear ventilation tube removed from a five-year-old child's chronically discharging ear. A review of the relevant international literature explores the role of biofilms in chronic infection and discusses potential intervention strategies.

Conclusion: Biofilms may be responsible for chronic middle-ear ventilation tube infection that resists treatment with conventional antibiotics.

Each year in the UK over 30 000 patients undergo insertion of grommets. The grommet insertion may cause many problems like persistent otorrhoea, scarred drum, retraction pockets and retention. The grommets may be extruded from the middle ears by the normal epithelial migration mechanism once they have served their purpose. These may become infected and require removal. We have analysed the Department of Health Hospital Episode Statistics relating to the insertion and removal of grommets (ventilation tubes). We have shown that 7.6 per cent of patients who have grommets inserted will have grommets removed.

The aim of this study was to compare the prevalence of the different types of eardrum pathology in a cohort of adults not previously treated by grommet insertion with corresponding findings obtained in a cohort previously treated with grommet insertion.

A cohort born in 1955 were invited to a screening examination including otomicroscopy. In the untreated cohort, retraction of Shrapnell's membrane was found in four per cent of the ears compared to 20 per cent in the cohort treated with grommets. Tensa pathology, including atrophy and myringosclerosis, was found in six per cent of the ears in the untreated cohort and in 17 per cent in the treated cohort. Normal eardrums were found in 91 per cent of the ears. Despite the increased awareness of secretory otitis, as well as the increased rate of surgical treatment, the prevalence of eardrum pathology seems to be increasing. The reasons for this are discussed.

Ossification of the tympanic membrane after myringoplasty is recorded for the first time. Myringoplasty was performed for closure of a perforation which followed the surgical treatment of Otitis media with effusion and had included the insertion of a long-term T-tube.

The object of this study was to compare the effect on the hearing of the insertion of a grommet, with or without adenoidectomy, against a non–surgically managed control ear in children with persistent hearing impairment due to otitis media with effusion.

Seventy–eight children (44 boys, 34 girls, mean age 5.8 years) with documented bilateral otitis media with effusion associated with a bilateral hearing impairment (pure tone average air conduction thresholds over 0.5, 1 and 2 kHz of ≥25 dB HL) over a three month period were admitted to a randomized, controlled trial. Each child was randomized to have or not to have an adenoidectomy. The ears in each child were then randomly allocated to have a grommet (tympanostomy tube) inserted. The children's hearing status was reviewed six and 12 months post–operatively. During follow–up, should a child redevelop a persistent bilateral hearing impairment (as defined above) for three months they were managed with a hearing aid. Thus no child had repeat insertion of a grommet.

Surgery of each type had an effect on the hearing and the presence of otitis media with effusion at six months post–operatively but not at 12 months when it was no different from natural resolution.

If resolution of the otitis media with effusion is the outcome measure, then adenoidectomy alone is significantly better than no surgery but only in boys rather than in girls. Even in boys it only resolves about 60 per cent of effusions. However, when combined with a grommet (one insertion) adenoidectomy gives no greater resolution (89 per cent compared with 86 per cent).

If improvement in hearing is the outcome measure, the overall results are similar. Adenoidectomy alone has an effect but if a grommet is inserted, adenoidectomy in addition does not improve the overall effect. However, these findings are not the case when analysed regarding the sex of the subject mainly because of the higher natural resolution rate in girls. In them, at six months surgery of any type or combination has no effect whereas in boys there is an additive effect of adenoidectomy on grommet insertion. Hopefully further studies can be conducted in larger numbers to investigate the differing effect in boys and girls suggested in this study.

Ever since Armstrong reintroduced the concept co grommeet insertion parents have been asking ‘may my child swim?’, yet there is still no consensus as to the correct answer. This paper reviews the work that has been done on this subject in the last 25 years. A review of teh reates of otorrhoea following grommet insertion, irrespective of swimming, shows a variation from 12 to 64 per cent. Evidence suggests that pressures of 12–23 cm H2O are needed to push water through a grommeet and that it is unlikely that water will enter the middle ear during surface swimming. Only bath water seems to cause significant inflammtory changes to middle ear mucosa. Not a single paper comparing swimming without ear protection can be safely permitted for children with grommets.

Ventilation tube (VT) insertion is an accepted treatment for chronic otitismedia with effusion (OME) in children. One hundred and eighty five children with bilateral OME were treated by unilateral myringotomy and VT insertion with no treatment to the contralateral ear. During a 5 year follow-up 95 of the children required only one VT but the remainer required more than one but always treatment was carried out to the same ear. The rate of development of tympanosclerosis was measured and scored. After 2–3 yearsthe extent of the sclerotic changes stabilised and the rate of development reached 37–39 per cent in ears receiving only one VT, compared with 47–49 per cent in ears treated by more than one tube. The extent of the changes was no different whether or not one or more than one tube had been inserted. There was no overall evidence of resolution of sclerotic change with time.