Tympanostomy Tubes Found in the Middle Ear Space: A Case Report

The placement of pressure equalization (PE) tubes is common procedure and often used for management of otitis media with effusion (OME), recurrent acute otitis media (AOM), and eustachian tube dysfunction (ETD) (Nagar and Deshmukh, 2022). PE tube insertion is thought to have minimal risk. It can be associated with complications such as otorrhea, tympanosclerosis, and eardrum perforation after the tube extrudes. Another less common complication is medialization of the tube into the middle ear space. This can occur during or after PE tube placement due to enlargement of the hole in the eardrum due to natural causes or persistent negative middle ear pressure. The literature reports the incidence of PE tube medialization for children between .5 percent and 1.1 percent. There is scarce literature on this phenomenon in adults.  

The authors of the current study report on a 36-year-old woman with a history of ETD. She previously had bilateral PE tube insertion due to ETD and recurrent otitis media. The left tube was thought to have migrated into her middle ear space. Surgical removal of the medialized PE tube was recommended. During the procedure, two tubes were unexpectedly identified in the middle ear space. The patient did not recall a second placement of a PE tube in her left ear, and available medical records did not document that procedure.

While medialization of a PE tube into the middle ear space is uncommon, it may have serious complications, such as otalgia, aural fullness, conductive hearing loss, and in extreme cases, significant damage to adjacent structures. The authors recommend professionals remain aware of this uncommon complication and continue to monitor patients closely with PE tubes to facilitate timely diagnosis and management should medialization occur.

References

Iyer, L. S., & Jeyakumar, A. (2026). Unexpected identification of two medialized tympanostomy tubes in an adult: A case report. Cureus. https://doi.org/10.7759/cureus.116172

Nagar, R. R., & Deshmukh, P. T. (2022). An overview of the tympanostomy tube. Cureus. https://doi.org/10.7759/cureus.30166