Skip to main content Accessibility help

Subannular tube insertion: anatomical considerations

  • A K Guidera (a1), L Benoiton (a2), L McManus (a3) and P J D Dawes (a4)



To assess the distance between the bony groove created during subannular tubes placement and the chorda tympani, and examine the depth of the hypotympanum and retrotympanum.


Grooves drilled in cadaver temporal bones at two levels were imaged to measure: the distance between the chorda tympani nerve and the tympanic sulcus, and the depth of the hypotympanum and the retrotympanum relative to the annulus.


The chorda tympani was between 0 and 5 mm from the groove cut across the annulus. The hypotympanum average depth was 2 mm (0.44–6.40 mm) and the retrotympanum average depth was 1 mm (0–2.53 mm).


Grooves drilled across the tympanic sulcus should be placed at a point 20 per cent of the height of the tympanic membrane or lower; this will ensure least risk of injury to the chorda tympani nerve. The depth of the hypotympanum and retrotympanum dictates that the posteroinferior part of a subannular tube flange should be approximately 2 × 1 mm.


Corresponding author

Address for correspondence: Assoc Prof P J D Dawes, ORLHNS Department, Dunedin Hospital, Private Bag 1921, Dunedin, New Zealand Fax: 00 64 3 474 7956 E-mail:


Hide All

Presented at the 65th Annual and General Scientific Meeting of the New Zealand Society of Otolaryngology – Head and Neck Surgery, 31 October 2012–2 November 2012, Wellington, New Zealand, and at the Australian Society of Otolaryngology Head and Neck Surgery 2013 Annual Scientific Meeting, 16–20 March 2013, Perth, Australia.



Hide All
1McLelland, CA. Incidence of complications from use of tympanostomy tubes. Arch Otolaryngol 1980;106:97–9
2Klingensmith, MR, Strauss, M, Connor, GH. A comparison of retention and complication rates of large-bore (Paparella II) and small-bore middle ear ventilating tubes. Otolaryngol Head Neck Surg 1985;93:322–30
3Kim, DS, Moore, PL, Rockley, TJ. Long-term Paparella II grommet use in the management of persistent otitis media: a 5-year follow-up study. Clin Otolaryngol 2004;29:553–7
4Kay, DJ, Nelson, M, Rosenfeld, RM. Meta-analysis of tympanostomy tube sequelae. Otolaryngol Head Neck Surg 2001;124:374–80
5Strachan, D, Hope, G, Hussein, M. Long-term follow-up of children inserted with T-tubes as a primary procedure for otitis media with effusion. Clin Otolaryngol 1996;21:537–41
6Vlastarakos, PV, Nikolopoulos, TP, Korres, S, Tavoulari, E, Tzagaroulakis, A, Ferekidis, E. Grommets in otitis media with effusion: the most frequent operation in children. But is it associated with significant complications? Eur J Pediatr 2007;166:385–91
7Simonton, KM. Ventilation tympanotomy. Tunnel technique. Arch Otolaryngol 1968;87:644
8Silverstein, H. Permanent middle ear aeration. Arch Otolaryngol 1970;91:313–18
9Jahn, AF. A biointegrated hydroxylapatite ventilation tube for definitive treatment of chronic eustachian tube dysfunction. Otolaryngol Head Neck Surg 1991;105:757–60
10Duadia, A, Yelavich, S, Dawes, PJ. Long-term middle-ear ventilation with subannular tubes. J Laryngol Otol 2010;124:945–9
11Martin-Hirsch, P, Woodhead, CJ, Vize, CE. Long-term ventilation of the middle ear using a tympanotomy technique. J Laryngol Otol 1995;109:1151–4
12Elluru, RG, Dhanda, R, Neely, JG, Goebel, JA. Anterior subannular T-tube for prolonged middle ear ventilation during tympanoplasty: evaluation of efficacy and complications. Otol Neurotol 2001;22:761–5
13Al-Swadi, W, Karlsmose, B, Gaihede, M, Henriksen, SD, Rosberg, J. Long-term treatment of chronic eustachian tube dysfunction by subannular ventilation tubes. Otol Neurotol 2005;26:301
14Jassar, P, Coatesworth, A, Strachan, DR. Long-term ventilation of the middle ear using a sub-annular tympanotomy technique: a follow-up study. J Laryngol Otol 2004;118:933–6
15Saliba, I, Boutin, T, Arcand, P, Freohlich, P, Abela, A. Advantages of subannular tube vs repetitive transtympanic tube technique. Arch Otolaryngol Head Neck Surg 2011;137:1210–16
16McManus, LJ, Dawes, PJ, Stringer, MD. Surgical anatomy of the chorda tympani: a micro-CT study. Surg Radiol Anat 2012;34:513–18
17Ott, I, Tebben, H, Losenhause, H, Issing, PR. Anatomical course of the chorda tympani nerve in middle ear surgery: clinical classification and relevance for postoperative gustatory dysfunction [in German]. Laryngorhinootologie 2009;88:592–8
18Haberkamp, TJ, Silverstein, HL. Permanent middle ear aeration: long-term follow-up of transosseous ventilating tubes. Laryngoscope 1987;97:1145–8
19Goplan, P, Kumar, M, Gupta, D, Phillips, JJ. A study of chorda tympani nerve injury and related symptoms following middle-ear surgery. J Laryngol Otol 2005;119:189–92
20Michael, P, Raut, V. Chorda tympani injury: operative findings and postoperative symptoms. Otolaryngol Head Neck Surg 2007;136:978–81


Subannular tube insertion: anatomical considerations

  • A K Guidera (a1), L Benoiton (a2), L McManus (a3) and P J D Dawes (a4)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed