We can see typical retro-tympanic fluid shown in green, and an air bubble (white circle) A linear radial myringotomy is performed in the anterior-inferior quadrant to avoid any ossicle injury. As you can see there is liquid behind the eardrum which is suctioned carefully without inducing sound trauma. The T-tube is inserted using micro-forceps, holding both flanges together to enable insertion through the myringotomy. Notice how the flanges are held proximally so that they can immediately deploy behind the eardrum as soon as the forceps grip is loosened. First the myringotomy is performed with a needle Make sure to open all the layers of the tympanum. The opening must be wide enough in order not to force tube entry. Once again, the Cohen T-tube is inserted anteriorly. Notice how the T-tube is gripped in the tube’s axis, to facilitate direct insertion. If insertion is not direct, the flanges can be pushed in one by one using a needle or a hook.