Studies on grommet materials and sizes are not exactly new but this was a well-designed randomized study in Sweden with some useful findings. The extrusion rate and complications associated with four different ventilation tubes (grommets) were assessed prospectively in 400 children over a 12-month period. The tubes tested were: two short tubes (length 2.2mm) and two long tubes (7mm), one each of silicone and fluoroplastic, all with a similar internal diameter. This was a rare find: a randomized surgical trial with similar demographics and indications for surgery among the groups and a low drop-out rate. Forty-two percent of the short tubes had extruded at 12 months compared with 10% of the long tubes (p<0.001). Purulent infection was seen in 5.2% of fluoroplastic tubes compared with 2.9% of silicone tubes; although statistically significant this appears a small clinical difference. While there are a few methodological shortcomings, such as difficulty blinding the assessors to the type of tube, it appears a very well-executed surgical study that answers a common question: which ventilation tube should I use? In this study the silicone long flange (Armstrong) tubes performed the best for the parameters studied. I’ll need to see if we have them on the shelf.
