CLINICAL CASES
CLINICAL CASES
Using the Wispr Digital Otoscope
Tympanostomy Tubes (ear tubes)
A 6-year-old male patient was brought into the emergency department by his mother, who explained that the child had a history of ear infections and “ear tube” placement. She became concerned that evening because the child stated his right ear “felt funny.” The child had no other complaints, but the mother sought evaluation due to his history of ear infections. Examination of his ears with the Wispr Digital Otoscope revealed the attached image.
Which of the following is(are) true?
A. The child’s tympanostomy tube (TT) is appropriately positioned
B. The child’s tympanostomy tube appears patent.
C. The child’s tympanostomy tubes likely have been placed within the past year
D. All of the above
Answer: D. All of the above
The child’s right TT is appropriately positioned. Typically, TTs are placed in the anteroinferior quadrant of the tympanic membrane (TM) where they provide good middle ear ventilation and avoid important structures, most notably the ossicles and chorda tympani nerve. It is not unusual for cerumen or epithelial debris to block the TT, rendering it non-functional. In this patient, the central TT opening still seems nicely patent without obvious obstruction. Most TT fall out within 12 to 24 months as epithelial migration (the normal process of TM renewal) gradually carries the TT radially. During this extrusion process, the TT may appear tilted, accumulate debris under its outer rim, or be located very near the annulus (outer edge) of the TM. This child’s TT does not demonstrate any of these findings, suggesting a more recent placement.
While the exact etiology of the child’s original complaint is not clear, reassurance was provided to the mother, and indications for follow-up were discussed.
