Contributors: Gresham T. Richter (University of Arkansas for the Medical Scienc)
1) Purpose: Untreated Eustachian Tube dysfunction can lead to retraction of the tympanic membrane (TM) and, eventually, an atelectatic middle ear. The insertion of a tympanostomy tube attempts to equalize the air pressure of the middle ear with the environment, allowing for the stabilization of the TM. Bobbin style tubes have an average extrusion time of less than a year while T-tubes remain in place longer but risk residual perforation. (1)
2)Instruments: Rigid endoscopes were used to direct and record the procedure with standard video monitoring. Straight cupped forceps were used to debride the external auditory canal. A myringotomy knife was used to make the myringotomy.
3) Landmarks: After debridement of cerumen, the handle of the malleus and the incudostapedial joint are clearly visualized as indicated with titles in the video. Note that the patient’s tympanic membrane shows an incudostapediopexy and deep retraction which is not the typical tympanic membrane position.
4) Procedure: Cerumen is debrided from the EAC. A myringotomy knife is used to enter the middle ear space which is suctioned. A t-tube is placed, and the position is confirmed.
5) Conflict of Interest and Source of Funding The authors have no financial disclosures.
6) References 1. Weigel MT, Parker MY, Goldsmith MM, Postma DS, Pillsbury HC. “A prospective randomized study of four commonly used tympanostomy tubes.” The Laryngoscope. 1989 Mar;99(3):252-6. http://dx.doi.org/10.1288/00005537-198903000-00003