Inability to Mask Ventilate During Myringotomy Tube Replacement: A Case Report

We present the case of a 3-year-old female with multiple congenital anomalies, including postprandial otorrhea, who developed the inability to be mask ventilated secondary to a combination of velopharyngeal insufficiency and tympanic membrane perforation. When applied by mask, positive pressure ventilation was observed to preferentially escape the patient's left ear, resulting in significant air leak, insufficient tidal volumes, hypoventilation, and severe hypoxemia. The problem was remedied by the insertion of a finger into the patient's external auditory meatus, which controlled the air leak until the surgical team could provide definitive surgical correction of the velopharyngeal insufficiency and nasopharyngeal reflux.