Complications
Otorrhea after tympanostomy tube placement occurs in up to 50% of patients.[93] This can be treated conservatively with debridement and topical antibiotics.
Tympanic membrane retraction is commonly seen in patients with chronic OME, as there is a chronic lack of ventilation of the middle ear.[111] When untreated, this can lead to progressive retraction of the tympanic membrane.[111] To monitor for this complication, routine otoscopy and audiologic assessments are indicated. To prevent and treat tympanic membrane retractions, tympanostomy tubes are placed, which allow ventilation of the middle ear.
Progressive retraction of the tympanic membrane can lead to erosion of the ossicular chain.[111] To monitor for this complication, audiologic testing should be performed routinely for patients with chronic OME. Ossicular chain erosion may present as worsening conductive hearing loss. Ossicular chain erosion may also be seen on otoscopy. To prevent ossicular chain erosion from tympanic membrane retraction, tympanostomy tubes are placed, which allow ventilation of the middle ear. To treat the conductive hearing loss stemming from ossicular chain erosion, ossicular chain reconstruction and hearing amplification are options.
Speech delay may be seen in children who have chronic OME due to hearing loss. Even mild hearing loss has been found to affect speech and language development.[112][113] To monitor for speech delay, patients with chronic OME should be re-evaluated on a regular basis. During these assessments, providers should ask parents about concerns regarding speech. To assist with the management of speech delay, hearing loss associated with OME should be treated promptly, such as with tympanostomy tube placement. Patients should also be referred to speech language pathology, when appropriate, for evaluation and therapy for speech.
Hearing loss has been associated with issues in school performance.[112][113] Children with chronic OME should be re-evaluated on a regular basis. During these assessments, providers should ask about school performance. Providers should also encourage parents to communicate their child's condition to the school so that classroom accommodations can be made.[114]
Tympanic membrane retraction can lead to retraction pockets that begin to accumulate keratin debris. If left untreated, this can lead to the formation of a cholesteatoma.[111] To monitor for this complication, otoscopy should be performed regularly in patients with chronic OME and there should be a low threshold for examination with a binocular microscope. Retraction pockets should be carefully monitored for keratin accumulation. To prevent and treat a retraction pocket, tympanostomy tubes may be placed. Tympanoplasty may be required to reconstruct the affected portion of the tympanic membrane. Patients with cholesteatoma may require tympanomastoidectomy for disease eradication.
Residual tympanic membrane perforation following tympanostomy tube extrusion can occur in up to 10% of patients.[94] Risk factors for residual perforation include previous tympanostomy tube placement and the placement of a longer-lasting tube.[94] Examples of long lasting tubes are butterfly, Paparella type II, Per-Lee, and Goode T-tube, while examples of short lasting tubes are Armstrong, Donaldson, Paparella type I, Reuter Bobbin, Shah, Sheehy, and Shepard tubes.[94]
Myringosclerosis is seen in approximately 30% of patients following tympanostomy tube placement.[115][116] Myringosclerosis may cause mild, moderate, or severe conductive hearing loss, and the severity of conductive hearing loss is not related to the extent of sclerosis.[117] Proposed risk factors for the development of myringosclerosis include repeated tympanostomy tube placement, duration of tube for longer than 12 months, larger tube diameter (>1.5 mm), a serous effusion at the time of tympanostomy tube placement versus a mucoid effusion, and an increased number of episodes of acute otitis media in the year preceding tympanostomy tube placement.[115][116]
This is commonly seen in chronic OME, both as a result of the effusion as well as complications occurring from an untreated chronic effusion (such as tympanic membrane retraction, ossicular chain erosion, retraction pocket, and cholesteatoma).[111] To monitor for hearing loss, routine audiologic assessments are indicated. To treat hearing loss resulting from chronic OME, tympanostomy tubes can be placed. Hearing amplification is also an option based on patient preference.
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