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Outcomes in children with perforated tympanic membranes after tympanostomy tube placement: results using a pilot
Scott A Schraff1, Jeffrey Markham, Camille Welch
1Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA 23507-1914, USA.
Insights
This study evaluated a treatment algorithm for pediatric tympanic membrane perforations after tympanostomy tube placement. The algorithm demonstrated high success rates, with 91% of perforations healing after the first intervention.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Medical Algorithms
Background:
- Tympanic membrane perforations (TMPs) can occur after tympanostomy tube (TT) placement.
- Management of TMPs following TT extrusion requires a structured approach.
- Retained tubes can contribute to persistent perforations.
Purpose of the Study:
- To assess the efficacy of a pilot treatment algorithm for TMPs in children post-TT placement.
- To evaluate the success rates of observation versus myringoplasty for these perforations.
Main Methods:
- Retrospective chart review of 95 children with TMPs after TT placement (1998-2003).
- Patients were managed using a defined algorithm involving observation or myringoplasty.
- Success rates were analyzed based on intervention type and perforation healing.
Main Results:
- 27% of patients had nonhealing perforations after tube extrusion, often due to retained tubes (median 48 months).
- The algorithm led to myringoplasty in 99% of cases (gelatin film/paper patch 76%, adipose 23%).
- Overall, 91% of TMPs healed after the first intervention; none required a third procedure.
Conclusions:
- The pilot treatment algorithm for pediatric TMPs after TT placement is highly successful.
- This algorithm serves as an effective model for managing such cases in clinical practice.
Purpose:
The objective of this study was to examine the success of a pilot treatment algorithm for tympanic membrane perforations in children after tympanostomy tube placement.
Materials And Methods:
A retrospective chart review of children with diagnosed tympanic membrane perforations after tympanostomy tube placement from 1998 to 2003 at a tertiary care children's hospital was performed. The patients had been treated according to an algorithm used by 2 pediatric otolaryngologists for management of tympanic membrane perforations: observation vs myringoplasty. Success rates were examined.
Results:
Ninety-five children were identified, 27% of whom had nonhealing perforations after tube extrusion; 73% of the perforations were caused by a retained tube. The median duration of tube retention was 48 months, ranging from 13 to 120 months. After the treatment protocol, 76% of the patients underwent gelatin film or paper patch myringoplasty, 23% had adipose myringoplasty, and 1% were observed. Overall, 91% had healed perforations after the first intervention. Among those requiring a second intervention, the sizes of initial perforations were between 15% and 40%, with postrepair perforation sizes between 5% and 40%. In addition, 75% of those requiring a second intervention underwent tympanoplasty repair and 25% had fat patch myringoplasty. None required a third intervention.
Conclusions:
Our treatment algorithm for children with tympanic membrane perforations after tympanostomy tube placement appears to be successful and is an excellent model for other clinicians.
