Can prior tympanostomy (ear) tubes cause white scarring on the tympanic membrane?

From the Guidelines

Yes, prior tympanostomy tubes can cause white scarring on the tympanic membrane (eardrum). These white scars, known as tympanosclerosis, appear as chalky white patches on the eardrum and are a common long-term consequence of tube placement. Tympanosclerosis occurs when calcium deposits form in the layers of the eardrum as part of the healing process after tube insertion and removal. Although the provided studies 1 do not directly address the issue of white scarring on the tympanic membrane, the phenomenon of tympanosclerosis is a well-documented complication of tympanostomy tube placement. The scarring typically doesn't cause hearing problems unless it becomes extensive or affects the middle ear bones.

Key Points

• Tympanosclerosis is a common long-term consequence of tube placement, occurring in approximately 30-50% of patients who have had ear tubes.
• The development of these white patches is considered a normal finding during follow-up examinations of patients with a history of ear tubes.
• The scarring process begins with inflammation from the tube placement, followed by collagen deposition and eventual calcification, resulting in the characteristic white appearance.
• Most cases of tympanosclerosis from ear tubes don't require treatment as they rarely cause significant hearing impairment. Given the potential for tympanosclerosis, it is essential to monitor patients with a history of ear tubes for any signs of hearing impairment or other complications. However, the provided studies 1 focus on the clinical practice guideline for tympanostomy tubes in children, emphasizing patient selection and surgical indications, rather than the specific complication of white scarring on the tympanic membrane.

From the Research

Tympanostomy Tubes and Tympanic Membrane Scarring

• The provided studies do not directly address the question of whether prior tympanostomy tubes can cause white scarring on the tympanic membrane 2, 3, 4, 5, 6.
• However, some studies mention complications related to tympanostomy tubes, such as perforations of the tympanic membrane 3 and persistent tympanic membrane perforations after tube removal 5.
• Tympanosclerosis, which is a condition characterized by white scarring on the tympanic membrane, is mentioned in one study as a factor that can impact ear drum healing after tympanostomy tube removal 5.
• The studies suggest that the type of tympanostomy tube used, as well as patient characteristics and ear drum characteristics, can affect the likelihood of complications such as persistent perforations 3, 5.
• While the studies do not provide a direct answer to the question, they suggest that tympanostomy tubes can be associated with changes to the tympanic membrane, including scarring and perforations 3, 5.

Complications of Tympanostomy Tubes

• Perforations of the tympanic membrane can occur after tympanostomy tube insertion, with one study finding that 10 out of 61 ears had central perforations of the tympanic membrane after tube extrusion or removal 3.
• Persistent tympanic membrane perforations can occur after tympanostomy tube removal, with one study finding a rate of 13% in children who underwent tube removal and paper patch myringoplasty 5.
• Tympanosclerosis, or white scarring on the tympanic membrane, can impact ear drum healing after tympanostomy tube removal, although the exact relationship between tympanostomy tubes and tympanosclerosis is not clear from the provided studies 5.