Abstract / Summary
Background and Clinical Significance: Tympanostomy tubes (TTs) are normally extruded into the external auditory canal within 6–18 months, whereas medial migration into the middle ear is a rare complication. Medialized tubes have been associated with otalgia, otorrhea, conductive hearing loss, granuloma and perilymphatic fistula, yet may remain clinically silent; no consensus exists on whether asymptomatic medialized tubes should be removed. Case Presentation: A 24-year-old man attended a routine otorhinolaryngological examination without otological complaints. He had undergone bilateral TT insertion at four years of age for otitis media with effusion, with complete resolution and no further otological procedures. Otoscopy demonstrated an intact tympanic membrane through which a round, blue structure was visible within the posteroinferior quadrant of the tympanic cavity; otoendoscopy confirmed a foreign body in contact with the middle ear mucosa. Tympanometry showed a type A curve and pure-tone audiometry showed normal, symmetrical thresholds. High-resolution computed tomography showed an aerated middle ear cleft, well pneumatized mastoid cavities, an intact ossicular chain and no radiological features of chronic otitis media. Conservative management was adopted, with clinical and audiological review planned at 6–12-month intervals; at the most recent review, three months after diagnosis, the patient remained asymptomatic. Conclusions: A medially migrated TT may be retained within the middle ear for two decades without inflammation, structural damage or hearing loss. In selected patients with an intact tympanic membrane, normal audiometry and unremarkable imaging, structured observation is a defensible alternative to removal, provided the patient is counseled about the symptoms that should prompt review.