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Subannular ventilation tubes: retrospective study
Jean-François Cloutier1, Pierre Arcand, Jose Martinez
1Otolaryngology Program, University of Montreal, Montreal, QC.
Insights
Subannular tube insertion is effective for long-term middle ear ventilation in pediatric patients with adhesive otitis or atelectasis. This safe technique offers an alternative to repeated short-term tube insertions, improving hearing outcomes.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Medical Devices
Background:
- Adhesive otitis and severe tympanic membrane atelectasis present challenges for middle ear ventilation.
- Recurrent otitis media and middle ear effusion often require repeated interventions.
- Eustachian tube dysfunction necessitates effective long-term solutions.
Purpose of the Study:
- To evaluate the efficiency of subannular tube insertion in pediatric patients.
- To assess tube duration, complication rates, and audiometric gain.
- To compare fluoroplastic and Goode T tubes for this specific indication.
Main Methods:
- Retrospective nonrandomized case series at a tertiary referral center.
- Analysis of 190 pediatric patients (316 tubes) aged 3-19 years.
- Outcomes measured included tube duration, complications, and audiometric gain.
Main Results:
- Average tube duration was 21.8 months; Goode T tubes lasted longer than fluoroplastic tubes.
- Audiometric analysis showed an average gain of 13.4 dB in speech reception threshold.
- Complication rates included otorrhea (17.7%) and perforation (7.9%); higher rates observed in younger children and reintervention groups.
Conclusions:
- Subannular tube insertion is a safe and effective method for long-term middle ear ventilation.
- This technique is suitable for adhesive otitis, atelectatic tympanic membranes, and eustachian tube dysfunction.
- It provides a valuable alternative to repeated short-term tube insertions for specific pediatric ear conditions.
Objective:
To evaluate the efficiency of a subannular tube insertion technique in a group of pediatric patients with adhesive otitis or severe atelectasis of the tympanic membrane.
Design:
Retrospective nonrandomized case series.
Setting:
Tertiary referral centre.
Main Outcome Measures:
The main outcomes of this study are tube duration according to the type of tube used, the complication rate, and the audiometric gain associated with this procedure.
Results:
The study group consisted of 190 patients (316 tubes) aged between 3 and 19 years (average 9 years old) and operated on between 1993 and 1999 by four pediatric otolaryngologists. The average follow-up was 53 months. The tubes remained in place for an average of 21.8 months, with fluoroplastic tubes lasting 17.8 months and Goode T tubes lasting 23.8 months. When used in children between 5 and 9 years of age and in cases of adhesive otitis, Goode T tubes showed statistically significantly better results than fluoroplastic tubes. The complications of this technique were otorrhea (17.7%), perforation (7.9%), a plugged tube (7.0%), and cholesteatoma (1.6%). The 5- to 9-year-old group and the reintervention group of patients showed statistically higher complication rates compared with all other groups. Sixty-four patients (128 tubes) were eligible for audiogram analysis, which showed a gain of 13.4 dB (speech reception threshold).
Conclusions:
The technique of subannular tube insertion is a safe and effective method for long-term middle ear ventilation in cases of adhesive otitis or severely atelectatic tympanic membrane or for patients with pathology related to dysfunction of the eustachian tube. It offers an alternative to repeated short-term tube insertions for otitis media with effusion or recurrent acute otitis media.
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