Unexpected Identification of Two Medialized Tympanostomy Tubes in an Adult: A Case Report

Tympanostomy tube placement is one of the most commonly performed otologic procedures and is widely used in the management of chronic otitis media with effusion (OME), recurrent acute otitis media (AOM), and Eustachian tube dysfunction (ETD). Although generally safe, complications may occur, and medialization of a tympanostomy tube into the middle ear space is a rare but recognized complication that may be associated with surgical removal due to the potential for chronic inflammation, conductive hearing loss, or middle ear injury. We present a case of two medialized tympanostomy tubes identified intraoperatively in the middle ear of a 36-year-old woman with bilateral ETD and no prior history of childhood ear disease or otologic surgery. The patient underwent left exploratory tympanoplasty with removal of two medialized tubes and right tympanostomy tube removal with patch repair, with an uncomplicated postoperative course. The outside operative documentation reported placement of one left T-tube; therefore, the timing and mechanism by which the second tube became medialized could not be established. This case highlights the unusual finding of two medialized tympanostomy tubes in an adult patient and underscores the importance of recognizing this rare complication and considering surgical management when clinically indicated.