Tympanostomy Tube Insertion

Tympanostomy tube insertion is a surgical procedure involving the placement of a ventilation tube through the tympanic membrane (eardrum) into the middle ear cavity. This establishes a direct communication between the middle ear and the external ear canal, which serves to equalize pressure, facilitate the drainage of middle ear effusions, and restore hearing function.

Indications for Tympanostomy Tube Insertion

It is primarily indicated for patients with chronic middle ear effusion refractory to medical therapy, or cases where repeated tympanocentesis has proven ineffective, particularly when accompanied by worsening hearing loss or viscous fluid accumulation, and when Eustachian tube function is not expected to recover shortly.

Pre-operative Considerations

1. The procedure is generally performed under local anesthesia.

2. The external auditory canal must be cleared of cerumen (earwax) preoperatively to ensure an aseptic surgical field.

3. For pediatric patients, effective communication between the physician and parents is essential to ensure the child's cooperation during the procedure.

4. Patients should avoid contracting colds or upper respiratory infections prior to surgery, as these conditions can compromise Eustachian tube function and increase perioperative risks.

5. Pre-operative assessment may include electronic nasopharyngoscopy or computed tomography (CT) of the temporal bone (including the middle ear and mastoid) to exclude underlying nasopharyngeal or nasal pathologies.

Post-operative Care

1. Maintain aural hygiene and keep the ear dry to prevent water ingress and subsequent infection.

2. Avoid vigorous nose blowing to prevent the reflux of nasopharyngeal secretions into the middle ear via the Eustachian tube, which could lead to otitis media.

3. Attend scheduled follow-up appointments to monitor the patency and position of the tube. Tube replacement may be necessary if it becomes obstructed or extruded prematurely.

4. The ventilation tubes are typically designed to remain in situ for a period of 6 to 12 months.

5. Strictly avoid water exposure to the operated ear during bathing or hair washing. Swimming is prohibited until the tube is removed.