A 4-year-old male returns to the pediatric clinic for a follow-up evaluation. Six months ago the child had ear tubes (tympanostomy or ventilation tubes) placed by ENT for recurrent acute otitis media. The mother reports that the child has been doing well. She has no concerns for her child today. The following image is obtained by the Wispr digital otoscope during the visit.
What should the mother be told about the ear tubes?
The child has a ventilation tube that appears to be partially extruded.
Ear tubes have several medical names. They are commonly referred to as tympanostomy or ventilation tubes. All three names, ear, ventilation, and tympanostomy refer to the same thing, the placement of a tube through the eardrum to drain fluid from the middle ear space and to equalize pressure on both sides of the eardrum. Normally, the Eustachian tube provides this drainage and equalization of pressure function. The Eustachian tube is a “floppy noodle-like” tube that extends from the middle ear space to the posterior nasal pharynx. This tube can become blocked by inflammation and infection leading to increased fluid and pressure in the middle ear. This is painful and causes a bulging ear drum. In children that have recurrent problems with Eustachian tube dysfunction, a ventilation tube like this one may be placed in the eardrum. This drains the fluid and equalizes the pressure. The tube is placed in the anterior-inferior quadrant of the eardrum by ENT during an office visit. The tube falls out on its own in 6 months or so.
In this case, the tube is performing as expected. There is no bulging of the ear drum and no evidence of fluid in the middle ear space. The malleus is clearly visible. Notably, the tube appears to be on its way out of the ear drum, as expected. The annulus of the tube is no longer flush with the ear drum suggesting the process of extrusion. Here is an example of a completely extruded tube.