Tympanostomy tube insertion

Tympanostomy tube insertion is a surgical procedure in which a tiny tube is inserted in the tympanic membrane, to bypass Eustachian tube dysfunction and to relieve persistent middle ear effusion.

Epidemiology

Tympanostomy tube insertion is the most frequent pediatric ambulatory surgery performed in the USA .
Around 667 000 children under 15 years are treated with tympanostomy tubes each year .

Surgical technique

Tubes are inserted usually in the anterosuperior quadrant of the tympanic membrane, under local or general anesthesia .
Placement in the anteroinferior quadrant is not recommended, to avoid injuries of the round window .

Indications

• chronic otitis media with effusion for more than 3 months
• middle ear effusion with recurrent acute otitis media

Contraindications

• one episode of otitis media with effusion resolving in less than three months
• no middle ear effusion even with recurrent acute otitis media

Complications

• short-term complications are
  • general anesthesia related complications
  • tympanic membrane perforation
  • injury to the round window leading to sensorineural hearing loss: if the tube is inserted in the anteroinferior quadrant of the tympanic membrane
• long-term sequelae are frequent, including
  • transient otorrhea
  • myringosclerosis
  • tympanosclerosis
  • tympanic membrane atelectasis
  • focal atrophy of the tympanic membrane
  • shallow retraction pockets
  • conductive hearing loss
  • occlusion of the tube
  • migration of the tympanostomy tube
  • water entry in the middle ear while showering, hair rinsing, or submersion underwater  

History and etymology

Armstrong performed in 1954 the first tympanostomy tube insertion, using plastic vinyl tubes, in five patients .