Medial Migration of Tympanostomy Tubes: The Why and What to do? Case report and Review of Literature

Bilateral myringotomy with tube insertion (BMT) is the most common surgery performed in the pediatric population. Many common complications after surgery have been widely discussed in the literature and include otorrhea, early extrusion of the tube, retained myringotomy tube, granuloma formation and even residual perforation. Majority of the complications after surgery are minor or resolve with topical antibiotic drops. A residual perforation may require myringoplasty if associated with infection and/or hearing loss. Medial migration of tympanostomy tube is a rare complication following tube insertion where the tube is displaced behind an intact tympanic membrane instead of following the natural path of extrusion towards the ear canal. Our case report and review of literature discuss the likely causes and pathogenesis of this unlikely complication following tube insertion. We also highlight preventative techniques especially during surgery that may prevent the development of this condition. Finally, management and follow up protocol of these patients is also discussed.