A 3-year-old with chronic ear infections had tubes placed six months ago. Current audiological battery shows normal hearing bilaterally, but tympanograms reveal a large volume in the right ear and a flat tracing with a small volume in the left ear. What is the next step?

A 3-year-old with chronic ear infections had tubes placed six months ago. Current audiological battery shows normal hearing bilaterally, but tympanograms reveal a large volume in the right ear and a flat tracing with a small volume in the left ear. What is the next step?

• A. VRA audiometry to determine status of hearing in each ear
• B. Referral to the ENT physician for further evaluation and treatment
• C. Retesting with a tympanometer that utilizes a 1000 Hz probe tone
• D. Irrigation of the ear in an attempt to determine whether the tube is blocked

Answer: (D)

Tympanostomy tubes change how tympanometry is interpreted. When a tubed ear shows a very large ear-canal volume, it usually means the tube is open and air can move between the external canal and the middle ear, making the measured space appear bigger. A flat tympanogram with a small volume on the other ear suggests the tube there may be blocked, isolating the middle ear from the canal and giving an abnormal, non-typical reading. The next step is irrigation of the ear to check whether the tube is blocked. Irrigation can both reveal blockage and often clear it if debris or mucus is present, restoring patency. If the tube is patent, irrigation won’t change that, and you would then consider other evaluations or management as needed. Since hearing is already normal, addressing the tube status directly is the most informative and efficient next move.

Tympanostomy tubes change how tympanometry is interpreted. When a tubed ear shows a very large ear-canal volume, it usually means the tube is open and air can move between the external canal and the middle ear, making the measured space appear bigger. A flat tympanogram with a small volume on the other ear suggests the tube there may be blocked, isolating the middle ear from the canal and giving an abnormal, non-typical reading.

The next step is irrigation of the ear to check whether the tube is blocked. Irrigation can both reveal blockage and often clear it if debris or mucus is present, restoring patency. If the tube is patent, irrigation won’t change that, and you would then consider other evaluations or management as needed. Since hearing is already normal, addressing the tube status directly is the most informative and efficient next move.