Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • 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. +++ Absolute + • Aural atresia.• Ectopic or aberrant carotid artery into the middle ear space. +++ Relative + • 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 ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth