Tympanostomy and Tube Placement

Description:

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

Pre-Operative Evaluation:

Audiogram to document degree of hearing loss may be performed.

Anesthesia:

Mask general

Surgical Technique:

  1. The patient is placed supine on the operating table and general anesthesia is induced via mask inhalation.
  2. The head is rotated to the side and the operating otomicroscope is brought into position over the external auditory canal.
  3. An otic speculum is used to visualize the canal, which is cleared of cerumen using a wax curette or microsuction.
  4. A myringotomy blade is used to make a radial incision in the tympanic membrane in the anterior-inferior quadrant.
  5. A Frazier tip suction is used to suction out any effusion that is present.
  6. A pressure equalization tube is inserted into the myringotomy.
  7. The ear is suctioned again to prevent blockage of the tube by clotted blood.
  8. The procedure may then be repeated on the opposite side, if indicated.
  9. Care of the patient is returned to the anesthesiologist for recovery.

Post-Operative Care:

  • 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).

Complications:

  • 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



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