Four Cases of Extraction of a Tympanostomy Tube that had Intruded into the Tympanic Cavity

Abstract

Among complications associated with tympanostomy tube insertion, intrusion of the tube into the tympanic cavity is very rare. We experienced 4 cases in which extraction of the tympanostomy tube was required because of intrusion into the tympanic cavity. Recurrent otitis media accounted for 2 cases, and otitis media with effusion for the other 2. General anesthesia was required in 3 cases for extracting the tubes. Endoscopy was effective for tube extraction in all cases.
We obtained information by means of a questionnaire concerning tympanostomy tube insertion from 68 otolaryngologists. In this questionnaire, the most common incident was perforation of the tympanic membrane, and the next most common incident was intrusion of the tube into the tympanic cavity. Two cases were settled out of court, both of which involved tube intrusion into the tympanic cavity.
Intrusion of the tube into the tympanic cavity might have occurred due to an early incident such as a large myringotomy incision, a delayed incident such as centrifugal migration of the epithelium leading to pressure in the tympanic cavity, or persistent negative middle ear pressure. Among the reported cases, 3 cases had a large myringotomy incision and 1 case experienced a delayed incident.
The intruded tube should be removed as soon as possible. However, it is necessary to explain the opinion of the previous surgeon to the patients to maintain the surgeon-patient relationship.
Informed consent, including the possibility of tube intrusion into the tympanic cavity, the method of tube extraction, and other tube-related complication in the tympanic cavity during tympanostomy tube insertion, should be obtained.