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Ventilation tube removal: does treatment affect perforation closure?
Kara M Schwartz1, Laura J Orvidas, Amy L Weaver
1Mayo Clinic, Mayo Medical School, Rochester, MN 55905, USA.
Summary
Most tympanic membrane perforations after ventilation tube removal heal spontaneously. Trichloroacetic acid (TCA) treatment may enhance closure, but further research is needed to confirm efficacy and reduce bias in perforation repair.
Area of Science:
- Otolaryngology
- Pediatric Otology
- Surgical Outcomes
Background:
- Ventilation tubes (VT) are commonly used to treat middle ear effusions.
- Tympanic membrane perforation can occur after VT removal.
- The need for interventions to promote perforation closure is an ongoing clinical question.
Purpose of the Study:
- To evaluate the impact of tympanic membrane treatment at the time of ventilation tube removal on perforation closure.
- To identify factors influencing tympanic membrane perforation healing after VT removal.
Main Methods:
- Retrospective chart review and telephone follow-up of pediatric patients undergoing VT removal between 1995 and 1998.
- Analysis of treatment modalities applied to the tympanic membrane post-VT removal, including 25% trichloroacetic acid (TCA).
- Assessment of perforation healing rates based on treatment received and reasons for VT removal.
Main Results:
- Of 162 ears, 93% healed without additional treatment after VT removal.
- Trichloroacetic acid (TCA) was the most common treatment (44% of treated ears).
- Lower failure rates were observed with TCA treatment (3%) compared to other treatments (13%) or no treatment (8%). Ears with otorrhea showed higher treatment failure.
Conclusions:
- The majority of tympanic membrane perforations resolve spontaneously after ventilation tube removal.
- Trichloroacetic acid (TCA) may be beneficial in promoting perforation closure.
- Further investigation via randomized clinical trials is recommended to validate TCA's efficacy and minimize potential bias.