Related Experiment Videos
Cholesteatomas associated with ventilation tube insertion
A Golz1, D Goldenberg, A Netzer
1Department of Otolaryngology-Head and Neck Surgery, Rambam Medical Center, Haifa, Israel. golz@netvision.net.il
Insights
Cholesteatoma formation after ventilation tube (VT) placement occurs in 1.1% of cases. Risk factors include younger age, specific tube types, multiple insertions, prolonged intubation, and post-operative otorrhea.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Otomicroscopy
Background:
- Ventilation tubes (VT) are commonly used to treat middle ear effusions.
- Cholesteatoma is a potential complication following VT insertion.
- Identifying risk factors for cholesteatoma is crucial for patient management.
Purpose of the Study:
- To determine the incidence of cholesteatoma formation associated with VT placement.
- To identify and analyze variables and risk factors predisposing to this complication.
Main Methods:
- Retrospective review of medical records for 2829 children undergoing VT insertion (1978-1997).
- Analysis of 1- to 20-year follow-up data for 5575 ears and 6701 VT placements.
- Cholesteatoma defined as developing at or near the VT insertion site.
Main Results:
- Cholesteatomas directly attributed to VT placement occurred in 1.1% of operated ears.
- Higher incidence observed in children <5 years, with Goode T-tubes, repeated insertions, intubation >12 months, and frequent post-operative otorrhea.
Conclusions:
- VT placement is associated with a 1.1% incidence of cholesteatoma.
- Informed consent regarding this risk is essential prior to surgery.
- Long-term otoscopic follow-up is recommended, especially for high-risk patients, to ensure early detection.
Objectives:
To determine the incidence of cholesteatoma formation associated with ventilation tube (VT) placement and to identify and analyze the variables and risk factors that may predict or predispose to this complication.
Design:
We reviewed the medical records of 2829 children following VT insertion between the years 1978 and 1997 to obtain 1- to 20-year follow-up data.
Setting:
Departments of Otolaryngology-Head and Neck Surgery and outpatient clinics of 2 tertiary referral academic medical centers.
Patients:
A study population of 2829 children, ranging in age from 1.2 to 14 years (5575 ears), underwent a total of 6701 VT placements.
Main Outcome Measure:
Cholesteatomas were considered a complication of VT placement whenever they developed at or near the site of the tube insertion.
Results:
Cholesteatomas directly attributed to VT placement occurred in 1.1% of the ears that were operated on. A higher incidence occurred (1) in children younger than 5 years, (2) when Goode T-tubes were used, (3) in cases with repeated insertions of tubes, (4) with intubation exceeding 12 months, and (5) in cases with frequent post-operative otorrhea.
Conclusions:
Cholesteatoma formation associated with VT placement occurs in 1.1% of the ears that are operated on, and therefore it should be discussed with patients or parents prior to surgery. Periodic and long-term follow-up microscopic examinations of the eardrum should be performed in all patients following tubal extrusion or removal, especially in those at high risk for developing a secondary cholesteatoma, to detect this complication as early as possible.