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EDITORIALS: Mark Haggard Insertion of ventilation (tympanostomy) tubes for otitis media with effusion BMJ 2008; 337: a1535 [Full text]

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Ventilation tubes are often unnecessary

Dr A. Breck McKay   (4 October 2008)

Re: Illustration for Ventilation tubes are often unnecessary

Graham J.C. Smelt   (7 November 2008)

Ventilation tubes are often unnecessary 4 October 2008
Dr A. Breck McKay, Family/Musculoskeletal Physicain Victoria Point, Queensland, Australia, 4165 Send response to journal: Re: Ventilation tubes are often unnecessary	In 1982, our practice of 4 family physicians, (managing a patient base of 8,500) was referring 3-4 children per week per doctor (600+ per annum) to ENT surgeons for insertion of grommets, following average 12 weeks of Eustachian tube obstruction following Otitis media infections, based on fibre optic naso-pharyngeal inspection, audiometry and tympanometry findings. Coincidentally we started using 'Kenacomb' ear cream to clear infected nasal infections and started to notice that the children who used it, had faster clearing of the nase and ears after Otitis media infections,often withing 3-5 weeks. By 1986 when we reviewed our referral rate we found it had dropped to a total of 16 for the whole year! Also noted was the better management of asthma, fewer cases of recurrent otitis media, 7sinusitis with no cases of chronic sinusitis in that year in children or adults. In 1986 'Kenacomb' ear cream was no longer marketed and we found the other similar products did not work as well, because many had ointment bases included. We then tried many mixes and now regularly use the following: 'Bactroban'(mupirocin calcium) cream 2x15 gm + 1% hydrocortisone cream 50g and 'Lamisil'(terbinafine)cream 15gm. This mix is very stable and one batch will last up to 12 months in the refrigerator without loss of efficacy. Application is by inserting a small piece (size of a cotton bud head), into the nares by using the little finger tip, twice a day for 1-2 weeks. This mixture consists of all water soluable components and it is transported over the surface of the nasal passages to the post basal area and down and across the openings of the Eustachian tubes, (by the normal cilia action of the nasal respiratory epithelium), thus clearing all nasal bacterial, fungal and inflammation and restoring normal front and post nasal area physiology and restoring normally functioning Eustachian tubes. The local chemists mix the combination and sell small aliquots (enough for 2-3 children for six months of 2-3 treatments each) at a reasonable price. It is amazing how many patients come back and ask for the 'Doctor's Nose Cream', many times over the following years, and how many other useful ways they have also found to use it! I now believe that many of the grommet insertions are totally unnecessary and all such children should have a trial of the nose cream treatment first, as it is much safer than the anaesthetic and surgery. Competing interests: None declared
Re: Illustration for Ventilation tubes are often unnecessary 7 November 2008
Graham J.C. Smelt, ENT Consultant Calderdale and Huddersfield NHS Foundation Trust Send response to journal: Re: Re: Illustration for Ventilation tubes are often unnecessary	The very arresting and attractive illustration accompanying this article, with which I agree wholeheartedly, shows a tympanostomy tube being inserted back to front! Occasionally some surgical imput concerning a surgical procedure is helpful. Competing interests: None declared