Blocked Ear Tube with AOM
A 6-year-old female is brought to the pediatric clinic by her mother with concern about ear pain. The child has had 3 days of viral symptoms including fever, cough, and runny nose. Yesterday, the child began to have right-sided ear pain. The mother has been managing the symptoms with an over-the-counter analgesic. The child has a history of ear infections. Six months ago, ventilation tubes (ear tubes) were placed to manage recurrent infections.
The child’s Wispr otoscope exam is shown. What is the appropriate intervention?
- The ventilation tube should be mechanically cleared.
- No intervention is necessary, this will spontaneously resolve.
- Antibiotics should be considered along with hydrogen peroxide drops.
- Blockage is almost always caused by an accumulation of cerumen (ear wax).
The answer is 3. Antibiotics should be considered along with hydrogen peroxide drops.
The child has an occluded tympanostomy (ear, ventilation) tube with evidence of acute otitis media (AOM).
Ear tubes are placed in the tympanic membrane to drain inflammation fluid from the middle ear space. This inflammation is from infections, often with a prodrome of viral symptoms. If the tube becomes clogged, fluid no longer drains from the middle ear, and pressure (bulging) and discomfort increase. In this image, the annulus of the tube is clearly obstructed. In addition, there is evidence of broad bulging of the ear drum, especially in the pars flaccida region. The bulging has almost completely obscured the malleus bone. Younis(1) has published a guide to managing plugged tympanostomy tubes. Dr. Younis notes that the plugging material is generally from the inflammatory middle ear fluid, not cerumen. Attempting to mechanically clear the tube is painful, traumatic, and generally not successful. Hydrogen peroxide drops clear the blockage 85% of the time. Because there is evidence of AOM in this case, antibiotics should be considered.
WiscMed has published a visual diagnosis guide to common ear conditions. This guide can be downloaded as a pdf here.
1 Prevention and Treatment of Plugged Tympanostomy Tubes, RT Younis, Ear, Nose & Throat Journal, Suppl 1, November 2007.