Care of the Child With Tympanostomy Tubes: A Visual Guide for the Pediatrician

Abstract

More than 2 million tympanostomy tubes are placed annually in the United States, primarily in children with chronic or recurrent otitis media refractory to nonsurgical management (J.S. Reilly, personal communication, 1994). Traditionally, the operating otolaryngologist has had the responsibility of caring for these patients, including: confirming middle ear disease, assuring tube patency, controlling refractory otorrhea, and managing complications such as tympanic membrane perforation or cholesteatoma. In response to pressures from a changing health care system, pediatricians are less able to refer children back to the otolaryngologist for routine tube surveillance, and must therefore perform it themselves, often with incomplete instrumentation and training. An approach is presented here for the care of the child with tympanostomy tubes based on the authors' combined experience with thousands of intubated children, and on available information from the pediatric and otolaryngic literature. With appropriate postoperative surveillance and follow-up care, the morbidity from tympanostomy tubes can be minimized. Although there are other ways of achieving the same goals, these time-honored methods are safe and effective. Because this is a visual guide, photographs are liberally interspersed to clarify and reinforce the written material. NORMAL TUBE APPEARANCE There are hundreds of different tube designs and materials and at least five different potential insertion sites in the tympanic membrane. This bewildering array of devices can be reduced to two general types: short-term tubes (intended to remain in the eardrum for 8 to 15 months) and long-term tubes (intended to remain in the eardrum > 15 months) (Fig 1A and B).