An unusual complication of T-tubes

Abstract

The morbidity of long-term ventilation tubes (Goode T-tubes) is often discussed with reference to otorrhoea, tympanosclerosis and long-term perforation. We report three cases of the T-tube slipping into the middle-ear cleft. In two of the three patients this was asymptomatic and the T-tubes were left in situ. In the third patient this complication was documented on three occasions when the T-tube was removed and reinserted for recurrent effusions. We are unaware of this complication being previously reported in the literature.

Medial migration of tympanostomy tubes: An overlooked complication

“…Prior case reports noted Goode, Shah, and Shepard tubes, none of which were seen in our study [11,12]. This suggests that the process of medial migration is not tube-dependent.…”

“…An extensive literature review revealed only two articles dedicated to this complication [11,12]. Both of these articles provide theories on medial migration.…”

“…This would prevent keratin from accumulating under the outer rim, and therefore, centrifugal migration would push the tube medially. In contrast, Green et al proposed that patient factors, such as an abnormally deep hypotympanic cleft, may allow tubes to become medially displaced [11]. Interestingly, both authors undervalue the severity of this complication and concur that in general, a medially migrated tympanostomy tube does not need to be surgically removed unless a patient is symptomatic.…”

“…This has been reported to occur at a rate of 0-1.1% [2][3][4][5][6][7][8][9], but represents the fifth most common indication for tympanostomy tube removal [10]. In contrast to cholesteatoma, this complication has only been specifically addressed in the literature in two case series [11,12]. Thorough descriptions of this phenomenon are therefore limited, and optimal management is not universally defined.…”

“…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][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][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.…”