• 
  

  • 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.