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Prolonged middle ear ventilation with the cartilage shield T-tube tympanoplasty
Larry G Duckert1, Kathleen H Makielski, Jan Helms
1Department of Otolaryngology-Head and Neck Surgery, University of Washington, Box 357923, Seattle, WA 98195-7923, USA. duckert@u.washington.edu
Background:
In 1994, the favorable experience with composite cartilage shield tympanoplasty was reported to the American Otological Society. On that occasion, the technical question regarding the concomitant placement of a ventilating tube was posed. In response, the authors proposed that the tympanostomy tube be incorporated in the cartilage graft. Moreover, they proposed that this marriage, when used to reverse atelectasis and to repneumatize the middle ear, should offer the advantage of both procedures while reducing the incidence of tube extrusion and other complications of prolonged intubation. Although attractive in theory, this supposition could be validated only after prolonged follow-up, reported here.
Objective:
To describe an effective means to secure prolonged middle ear ventilation in a patient population prone to atelectasis and chronic middle ear effusion and to establish the incidence of favorable and unfavorable outcomes after 6 years of observation.
Study Design:
Retrospective case series.
Setting:
Tertiary referral center.
Patients:
Forty patients (28 adults and 12 children) who underwent tympanic membrane reconstruction with a composite cartilage shield T-tube "unit."RESULTS The overall retention rate was 62.5% over 6 years. Sixty-five percent of retained tubes were maintained for a minimum of 4 years in adult patients. Extrusion and permanent perforation rates were 0%.
Conclusion:
The cartilage shield T-tube tympanoplasty can effectively reverse atelectasis and provide prolonged middle-ear ventilation. The technique can be used safely and minimizes the risk of tympanic membrane perforation and other complications associated with prolonged middle ear intubation.