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Now eustachian tube, is a tube which connects your nose with your ear. It is also called as the auditory tube or the ventilator tube. It allows the air from the nose to get int the middle ear and ventilates the middle ear, so that there is a similar pressure across the eardrum, that means on the outer part of the eardrum as well as the inner part of the eardrum, the air pressure is maintained at the same level, so that sound can pass through the eardrum into the inner ear without any impedance or a blockage. Eustachian tube dysfunction can occur for various reasons, the commonest being recurrent cold, sinusitis, a tumor pressing on eustachian tube or in some people, we cannot just make out why it happens, eustachian tube just decides one fine day that will not function any more. So when the eustachian tube doesn’t function properly, it slowly creates a negative pressure in the middle ear, because if the air is not passing and whatever air is remaining in the middle ear is gets absorbed. So that creates a vaccum and it leads to sort of negative pressure. This will pull the eardrum inside. It will also lead to some amount of fluid accumulation in the middle ear. Now, everything doesn’t happen at the same time. It is a process in continuum, that means at various stages of the disease, you will see various things and , and early stage we may see as slight retraction of the eardrum, sometimes we will see air bubbles, sometimes we may see fluid, sometimes we never see air bubbles or fluid, but the retraction just tends to be like that and it doesn’t open up on trying to pop the nose, and one of the symptoms with which the patient can come to us with tinnitus. To what people need to be aware of is a tinnitus is produced not only because of this, but because of various other reasons, some of which can be recognized by tests and clinical examination, and some of which we may ever be able to identify, but if the patient is presented to us , symptoms of say upper respiratory tract infection or a cold or a sinusitis, followed by ear blockage, noise in the ear and everything else settles down with medication, but the tinnitus has not settled down, despite medications for 2 or 3 weeks, then I would be confident to say that you introduce a grommet and that they may reduce the tinnitus or it may help the tinnitus to vanish. Now the premise for such a recommendation is the moment we keep a grommet, the grommet will act like an artificial ventilation tube. The grommet will allow the air pressure across the eardrum to be maintained. So that is how a decision is made, but since tinnitus can be because of many other reasons, there is no guarantee that all types of tinnitus can be treated with grommets.
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