Tympanostomy tube insertion
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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.
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Tympanostomy tube insertion is the most frequent pediatric ambulatory surgery performed in the USA 1.
Around 667 000 children under 15 years are treated with tympanostomy tubes each year 1.
Tubes are inserted usually in the anterosuperior quadrant of the tympanic membrane, under local or general anesthesia 2.
Placement in the anteroinferior quadrant is not recommended, to avoid injuries of the round window 2.
- chronic otitis media with effusion for more than 3 months 1
- middle ear effusion with recurrent acute otitis media 1
- one episode of otitis media with effusion resolving in less than three months 1
- no middle ear effusion even with recurrent acute otitis media 1
- short-term complications are 1,2
- 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 1,2
- transient otorrhea
- 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 2.
- 1. Rosenfeld HH, Rosenfeld HD, Rosenfeld KT, Rosenfeld LD, Rosenfeld LK, Rosenfeld MW, Rosenfeld NJ, Rosenfeld PM, Rosenfeld RN, Rosenfeld SK, Rosenfeld. Clinical practice guideline: Tympanostomy tubes in children. (2013) Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. doi:10.1177/0194599813487302 - Pubmed
- 2. Morris M, Morris. Tympanostomy tubes: types, indications, techniques, and complications. (1999) Otolaryngologic clinics of North America. doi:10.1016/s0030-6665(05)70140-7 - Pubmed