• Otitis media with effusion (OME) persisting longer
than 3 months.
• Hearing loss > 30 dB in patients with OME.
• Recurrent episodes of acute otitis media.
• Barotrauma and patients undergoing hyperbaric oxygen therapy.
• Otitis externa causing stenosis of the external
• High-riding jugular bulb into the middle ear space.
• Mass behind the tympanic membrane.
• Risks of anesthesia.
• Temporary; usually resolves spontaneously within 24 hours.
• Due to outer ear or ear canal laceration.
• Due to myringotomy incision.
• Due to inflamed middle ear mucosa.
• Otorrhea occurs in approximately 20–30% of
patients with tympanostomy tubes.
• Postoperative otorrhea (16%): Most likely related
to the presence of purulent fluid or inflamed middle ear mucosa.
• Recurrent otorrhea (7–26%): Usually occurs
due to another episode of acute otitis media.
• Persistent or chronic otorrhea (3.8%): Can occur from reactive
inflammation to the tube itself and may require tube removal.
• Tympanic membrane perforation occurs in 5–15% of patients.
• Short-term ventilation tubes: Less than 5%.
• Long-term ventilation tubes: Higher rate of perforation at approximately
• Less than 3% require surgical closure of the perforation.
• Tube that is retained for longer than 5 years, with or without
granuloma formation, can act as a foreign body.
• If the patient has chronic unresolving otorrhea or granulation
tissue around the tympanostomy tube, it should be removed.
• Granulation tissue formation occurs in approximately 5% of
• Medial displacement of the tympanostomy tube (0.5%); not
• Myringosclerosis is the submucosal hyaline degeneration in the
fibrous layer of the tympanic membrane, resulting in a whitish “plaque.”
• Can occur in as many as 30–40% of patients
with tympanostomy tubes.
• In most cases, there is no clinical significance.
• Other structural changes of the tympanic membrane.
• Clinicians should use pneumatic otoscopy as the
primary method to diagnose OME.
• During the myringotomy and tube insertion, be careful not to ...
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