Tympanostomy and Tube Placement
In this procedure, an incision is made in the tympanic membrane (TM), any fluid (effusion) is drained and a pressure equalization tube (PET) is inserted into the TM.
Indications for Surgery:
Otitis media with effusion resulting in significant hearing loss (>20 dB), functional impairment (speech or language delay), or structural changes to the tympanic membrane (e.g., severe retraction pocket). The procedure may also be considered if effusion persists for >4 months, if the patient is at high risk for developmental delay, or if the patient has comorbidities that predispose to persistent effusion (e.g., craniofacial anomalies).
Contraindications to Surgery:
- Medical comorbidities that would preclude surgical or anesthesia risk
- Ear canal atresia or stenosis
Audiogram to document degree of hearing loss may be performed.
- The patient is placed supine on the operating table and general anesthesia is induced via mask inhalation.
- The head is rotated to the side and the operating otomicroscope is brought into position over the external auditory canal.
- An otic speculum is used to visualize the canal, which is cleared of cerumen using a wax curette or microsuction.
- A myringotomy blade is used to make a radial incision in the tympanic membrane in the anterior-inferior quadrant.
- A Frazier tip suction is used to suction out any effusion that is present.
- A pressure equalization tube is inserted into the myringotomy.
- The ear is suctioned again to prevent blockage of the tube by clotted blood.
- The procedure may then be repeated on the opposite side, if indicated.
- Care of the patient is returned to the anesthesiologist for recovery.
- The procedure is performed on an outpatient basis.
- Patients may be discharged on a short course of antibiotic ear drops.
- Follow-up examination and audiogram should be arranged in 2-4 weeks.
- No specific water precautions are recommended as there is no evidence that this reduces otorrhea (ear discharge).
- Bleeding from ear
- Premature tube extrusion
- Tube blockage
- Tympanostomy tube otorrhea (if persistent, the tube may need to be removed)
- Persistent tympanic membrane perforation after tube extrusion
- Dislocation of tube into the middle ear space
- Injury to middle ear structures