An unusual complication of T-tubes

What to do with medialized tympanostomy tubes? A survey of pediatric otolaryngologists

INTRODUCTION

Tympanostomy tube placement is the most common surgical procedure performed in children. Medial migration of a tympanostomy tube is a rare occurrence where the tube migrates into the middle ear cavity as opposed to its normal extrusion into the external auditory canal. Whether medialized tympanostomy tubes should be surgically removed in asymptomatic patients is controversial. The objective of this study was to determine experience and management approach of medialized tympanostomy tubes among pediatric otolaryngologists.

METHODS

A 12-question cross-section survey was designed and distributed to the American Society of Pediatric Otolaryngology (ASPO) members. The survey study was granted McGill University institutional review board and ASPO research committee approval. The survey data were filtered and cross-tabulated. Descriptive statistics were generated.

RESULTS

128 pediatric otolaryngologists completed the 12-question survey. The majority of respondents had experienced at least one case of medialized tympanostomy tube (90.6%). The majority of patients (82.0%) were asymptomatic. 74 out of 128 respondents (57.8%) indicated that they would not remove a medialized tube in an asymptomatic patient. However, 7.0% of those respondents clarified that they would proceed to surgical removal if the patient were undergoing general anesthesia for another surgery. 30.5% of respondents indicated that they would surgically remove the tube even if the patient were asymptomatic. 6.3% of respondents indicated that opted management in children would be based on a shared decision with parents. Most respondents (80.5%) did not experience complications with surgical removal nor with elected observation.

CONCLUSION

There is no consensus among pediatric otolaryngologists regarding the necessity of surgically removing a medialized tympanostomy tube in asymptomatic patients. The survey suggests that both options are acceptable. If observation is chosen, it is important that parents are well informed of the potential long-term sequelae of a medialized tube and advised to consult if symptoms occur.

Case of perilymphatic fistula caused by medially displaced tympanostomy tube

Objective:

We present a rare case of perilymphatic fistula which occurred due to bony erosion by a tympanostomy tube that had migrated into and become interred in the middle-ear space.

Method:

We present a case report and a literature review concerning migration of tympanostomy tubes into the middle ear as a complication of tubes insertion.

Conclusion:

Medial migration of tympanostomy tubes into the middle-ear space is a rare complication of tympanostomy tubes insertion. To our knowledge, this is the first report of perilymphatic fistula caused by a tympanostomy tube which had migrated into the middle ear. This case highlights the need for early removal of tympanostomy tubes which migrate into the middle ear.

To remove or not to remove: Review of cases of medial migration of tympanostomy tubes

OBJECTIVE

Few cases of medial migration of tympanostomy tubes have been reported and its optimal management has not been well delineated especially in asymptomatic patients. The aim of this review is to present all cases of medialized tympanostomy tubes reported in the literature in order to provide the most beneficial management option.

METHODS

Eligible articles were identified through a comprehensive search in Cochrane, Embase and Medline electronic databases. Two reviewers independently screened the data sources, using pre-defined inclusion criteria to generate a list of eligible articles. Data extracted included patient demographics, diagnosis, type of tube, timing of migration, presenting symptoms, examination outcomes, treatment and follow up.

RESULTS

10 articles were chosen for data extraction from which 29 patients presenting with medial migration of tympanostomy tube were identified.

CONCLUSION

The low complications associated with removing a medialized tube and the risk of leaving foreign objects in the middle ear cleft make myringotomy for removal of the tube a practical and safe management option for medialized tubes even in asymptomatic patients.

Medial migration of tympanostomy tubes: an overlooked complication

BACKGROUND

Frequently encountered complications associated with tympanostomy tube placement have been well documented and are globally recognized. The medial migration of tympanostomy tubes into the middle ear space is a rare complication for which pathogenesis, natural history, and management have not been clearly delineated.

OBJECTIVE

To describe our experience with the medial migration of tympanostomy tubes into the middle ear space. To propose a simple classification system and define management recommendations.

METHODS

A retrospective chart review of all patients with medial tube migration seen in a Pediatric Otolaryngology practice at a tertiary care university hospital between 1995 and 2005.

RESULTS

Six pediatric patients (ages 3-19) were found to have seven tympanostomy tubes within the middle ear space at various intervals following tube placement. One patient had a migrated tympanostomy tube deep to a large myringotomy incision. Five patients (six ears) had migrated tubes medial to intact, healed tympanic membranes. Fifty percent of the patients had symptoms attributable to the migrated tube. All six patients underwent middle ear exploration with successful removal of the migrated tube.

CONCLUSIONS

This process can be defined as primary, when the tympanostomy tube migrates due to a technical error, or secondary, when the tube is initially seen in the correct position but is later found medial to a healed, intact tympanic membrane. Medial migration is apparently independent of tube type and can occur at various intervals after placement. The process of secondary migration is most likely multifactorial but may in part be the result of persistent negative middle ear pressure. Migrated tubes should be removed surgically unless contraindicated.