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  • • Otitis media with effusion (OME) persisting longer than 3 months.

    • Hearing loss > 30 dB in patients with OME.

    • Recurrent episodes of acute otitis media.

    • • More than 3 episodes in 6 months.

      • More than 4 episodes in 12 months.

    • Barotrauma and patients undergoing hyperbaric oxygen therapy.




  • • Aural atresia.

    • Ectopic or aberrant carotid artery into the middle ear space.




  • • Otitis externa causing stenosis of the external auditory meatus.

    • High-riding jugular bulb into the middle ear space.

    • Mass behind the tympanic membrane.


  • • Microscope.

    • Ear speculum.

    • Cerumen curette.

    • Myringotomy knife.

    • Suction cannula (3F, 5F, and 7F) with suction canister and apparatus for cultures.

    • Tympanostomy tube.

    • • For children aged 6 months to 2 years, use short-term ventilation tubes (eg, straight tube, grommet tube, Reuter collar button tube).

      • For children aged 3–5 years with chronic eustachian dysfunction (such as children with cleft palates), use long-term ventilation tubes (eg, T-tubes or large inner-flanged tubes).

    • Alligator forceps.

    • Ear pick.


  • • Risks of anesthesia.

    • Bleeding.

    • • 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 15%.

      • 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 patients.

    • Medial displacement of the tympanostomy tube (0.5%); not a problem.

    • 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.

    • • Flaccid tympanic membrane (25%).

      • Retracted tympanic membrane (3.1%).

    • Cholesteatoma.

    • • Occurs in less than 1% of patients.

      • May result from squamous debris being trapped in the middle ear around the tympanostomy tube.


  • • 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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