Ventilating Tube Insertion

Indications 

The most common indication for ear tube insertion remains persistent (> 3 mo) otitis media with effusion (OME), or serous otitis media (SOM), that does not resolve after 3 months of clinical observation or does not improve with antibiotic therapy. Ear tube insertion promotes drainage of middle ear fluid, which can cause speech and language delay if left untreated for a prolonged period. Middle ear fluid also predisposes to recurrent infections.

Another indication for ear tube insertion is acute otitis media (AOM) that is refractory to antibiotic therapy. I

Additional indications for prompt ear tube insertion include complications of AOM, such as meningitis, facial nerve palsy, and otomastoiditis. 

Expected Outcomes

Overall, 80% of children requiring ear tubes need 1 set of ear tubes. In children with ear tubes, episodes of otitis media are less frequent and are more readily treated with antibiotic ear drops.

Surgical Technique 

An operating microscope with a 250-mm lens is brought into the field and focused on the external auditory meatus. A speculum is placed into the external auditory canal, and the cerumen is removed so that the entire tympanic membrane can be visualized. 

A horizontal incision is placed over the region of the middle ear, most commonly in the anteroinferior quadrant. 

If an effusion is present, a  suction cannula is employed. Large suction cannulas are essential for removing the thick inspissated fluid that is frequently present in chronic otitis media with effusion (OME).

An ventilating tube is introduced and then passed through the speculum and inserted into the drum. 

Complications of Procedure

Complications that can occur after ear tube insertion include the following:

Tympanic membrane perforation - This occurs in 1-2% of patients with short-term tubes 
Otorrhea after tympanostomy tube insertion - This is treated initially with antibiotic ear drops; occasionally, children experience persistent ear tube drainage that necessitates prompt removal of the tube
Extrusion - Ear tubes extrude spontaneously after an average of 13.8 months; a second set of tubes can be considered if otitis media recurs with early extrusion or blockage of the lumen
Tympanosclerosis, focal atrophy, and shallow retraction pockets - These sequelae are more common after ear tube insertion; however, they do not affect long-term hearing.