الفهرس 
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Abstract
All cases underwent to TTs insertion ranged from 3 – 70 years. Most of patients were less than 12y. Male to female ratio was 144/76. There were 378 operated ear with TT insertion: 286 ears with grommet tube (75.7%) and 92 ears with T type tube (24.3%). Problems which detected in 198 ears were: 82 difficulties during insertion of TT, 42 complicatios early after tube insertion (within the first month) and 74 complications late after tube insertion (after one month of TT insertion and till 6 months follow up). The most common problem during insertion of TTs was the thick mucoid discharge in 22 ears (5.8%) then narrow external auditory canal in 16 ears (4.2%) then anterior hump at external auditory canal in 14 ears (3.7%) then bleeding during insertion in 12 ears (3.2%) (10 from canal wall and 2 from margins of incision) then shallow middle ear cavity in 4 ears (1%) and very thin tympanic membrane in 4 ears (1%) and difficult insertion in 4 ears (1%) also then very large myringosclerotic patch in 2 ear (0.5%), difficult handling of instruments in 2 ear (0.5%), medially displaced TT in 2 ears (0.5%) also. Complications occurred at the first month postoperatively considered early complications. The most common problems early after insertion of TTs were otorrhea in 20 ears (5.3%) then early extrusion of tubes in 8 ears (2.1%) and plugged tube in 8 ears (2.1%) then otitis externa in 4 ears (1 %) then falling of tube in M.E. in 2 ears (0.5%). Many complications occurred late after surgery. In the present study there were 74 late complications happened in 68 ears occurred after one month of tube insertion and for 6 months follow up. The most common late complications occurred were plugged tubes in 24 ears (6.3%), recurrence of the pathology (otitis media with effusion) in 16 ears (4.2%), residual perforation in 12 ears (3.2%), late otorrhea in 10 ears (2.6%), myringosclerosis in 6 ears (1.6%), granulation tissue in 4 ears (1%) and focal atrophy in 2 ears (0.5%). Most parents are willing to accept these minor risks in return for improvements in their children’s hearing impairment and reduction in ear infections. However, in the majority of cases, these complications resolve with conservative management, some times we need to remove tube manually as in plugged tube not respond to treatment, we may need to surgical intervention in some cases such as myringoplasty in residual perforation.