[Pro or contra drainage of the tympanum].

Ventilation tubes ("grommets") appear to be the logical treatment of chronic secretory otitis media, based on the theory of its pathogenesis. Usually they have an impressive immediate effect, and enjoy great popularity. However, there are critics who restrict the indications, for two reasons: it has been observed repeatedly that the spontaneous healing rate in secretory otitis media is about 80%, and follow up studies over several years suggest that persistent lesions of the middle ear (scars and defects of the tympanic membrane, conductive hearing loss, cholesteatoma etc.) occur somewhat more often in grommet-treated ears than in ears without ventilation tubes. A therapeutic advantage of ventilation tubes in the resolution of chronic secretory otitis media has not been proved. Therefore, according to our present knowledge the only treatment effect of ventilation tubes is the immediate elimination of conductive hearing loss. As development studies in children suggest that a conductive hearing loss does not become a handicap for speech and mental development unless it has persisted for several months, ventilation tubes seem to be indicated only when a bilateral middle ear effusion of greater than 25 dB persists for more than 3 months. However, in children with delayed speech development one should not wait such a long time, because they particularly depend upon normal hearing ability.