Limited benefit from grommets for recurrent acute otitis media in children

Limited benefit from grommets for recurrent acute otitis media in children

Brian McAvoy
Clinical question

How effective is bilateral grommet insertion with or without concurrent adenoidectomy in children with recurrent acute otitis media (rAOM)?

Bottom line

Current evidence is limited to 5 randomised controlled trials with unclear or high risk of bias. Low to very low‐quality evidence suggests children receiving grommets are less likely to have rAOM at 6 and 12 months of follow‐up compared with those managed by active monitoring and placebo medication, but the magnitude of the effect is modest with around one fewer episode at 6 months (number needed to treat to benefit; NNTB = 3) and a less noticeable effect by 12 months (NNTB = 8). Low‐quality evidence suggests disease‐specific quality of life is similar at 4 and 12 months in children receiving grommets and those managed by active monitoring. It is uncertain whether or not grommets are more effective than antibiotic prophylaxis. The risk of persistent tympanic membrane perforation after grommet insertion is low (low‐quality evidence).


Widespread use of pneumococcal vaccine has changed the bacteriology and epidemiology of AOM. All of the trials in this review were conducted prior to introduction of the vaccine. There were insufficient data to determine whether presence of middle-ear effusion at randomisation, type of grommet or age, modified the effectiveness of grommets. In none of the studies was adenoidectomy performed concurrently in both groups.


AOM is one of the most common childhood illnesses. Many children experience sporadic AOM episodes, but an important group suffer rAOM, defined as 3 or more episodes in 6 months, or 4 or more in 1 year. In this subset of children, AOM poses a true burden through frequent episodes of ear pain, general illness, sleepless nights and time lost from nursery or school. Grommets, also called ventilation or tympanostomy tubes, can be offered for rAOM.

Cochrane Systematic Review

Venekamp RP et al. Grommets (ventilation tubes) for recurrent acute otitis media in children. Cochrane Reviews, 2018, Issue 5. Art. No.: CD012017.DOI: 10.1002/14651858. CD012017.pub2. This review contains 5 studies involving 805 participants.