2017 Volume 120 Issue 6 Pages 811-816
The Japanese guideline for otitis media with effusion recommends insertion of a tympanotomy tube in cases with contact or adhesion of the tympanic membrane. However, there are complications associated with the insertion of a tympanotomy tube, such as perforation and retraction of the tympanic membrane. In an attempt to minimize such complications, we performed subannular tube insertion. We reviewed 11 cases (13 ears) of adhesive otitis media, atelectatic ear or chronic otitis media with perforation, that had received subannular tube insertion. The tube insertion was performed under general anesthesia in all the cases. A radial incision was made on the postero-inferior wall of the external auditory canal, the tympanomeatal flap was elevated with the fibrous annulus, and then a Goode T-tube was inserted into the middle ear under the fibrous annulus; the tube was then covered with a meatal flap. At more than 3 months after the surgery, the tube was still found in situ in 7 of the 13 ears. The average duration of the tube remaining in situ was 9 months (1-29 months). The condition of the tympanic membrane was satisfactory in the cases in which the tube remained in situ. This method allowed ventilation of the middle ear, rendering tympanotomy unnecessary. It was useful for the treatment of persistent otitis media with effusion, atelectatic ear and adhesive otitis media, while preventing complications such as perforation and retraction tympanic membrane. However, in almost a half of the cases, the tube failed to be retained in situ. We need to develop a method to prevent early extrusion of the tube.
