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Updated: Jan 2, 2026
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Factors affecting persistent tympanic membrane perforation after tympanostomy tube removal in children
Clarice Brown1, Philomena Behar2
1UTSW Medical Center, Department of Otolaryngology, F6.221, 2350 N. Stemmons Freeway, Dallas, 75207, Texas, USA.
Insights
Persistent tympanic membrane perforations are more common after long-term tympanostomy tubes (TTs). Factors like patient age and perforation size influence ear drum healing post-TT removal and paper patch myringoplasty (PPM).
Area of Science:
- Otolaryngology
- Pediatric Otology
- Surgical Outcomes
Background:
- Tympanostomy tubes (TTs) are frequently used in children to manage otitis media.
- Persistent tympanic membrane (TM) perforations can occur after TT removal.
- Paper patch myringoplasty (PPM) is often performed concurrently with TT removal to aid perforation closure.
Purpose of the Study:
- To compare persistent perforation rates after short-term versus long-term tympanostomy tube use.
- To identify demographic, anatomical, and physical factors influencing TM healing after TT removal and PPM in children.
Main Methods:
- Retrospective chart review of patients under 18 years old.
- Data collected from January 2005 to January 2017 for TT removal with concomitant PPM.
- Analysis of 343 ear drums to assess perforation status and associated factors.
Main Results:
- Overall perforation closure rate was 87% after TT removal and PPM.
- Persistent perforation rate was significantly higher with long-term TTs (20%) compared to short-term TTs (6.6%).
- Factors associated with persistent perforations included patient age, number of TTs received, TM perforation size, and tympanosclerosis.
Conclusions:
- The combination of TT removal and PPM achieves an 87% closure rate for tympanic membrane perforations.
- Long-term tympanostomy tube use is associated with a significantly higher rate of persistent perforations.
- Patient and ear drum characteristics play a role in the success of perforation closure after tympanostomy tube management.
Objectives:
Evaluate and compare the rates of persistent tympanic membrane (TM) perforations between short-term vs long-term tympanostomy tubes. In addition, to determine which demographic, anatomical, and physical factors affect ear drum healing after tympanostomy tube (TT) removal and simultaneous paper patch myringoplasty (PPM) in children.
Study Design:
Retrospective chart review.
Methods:
Charts were reviewed from the Women and Children's of Buffalo hospital and our pediatric otolaryngology practice electronic medical record. Data was retrieved from patients less than 18 years old who underwent surgical removal of a TT and concomitant PPM between January 2005 and January 2017.
Results:
343 ear drums were studied that underwent tympanostomy tube removal and paper patch myringoplasty. 45/343 (13%) of ears had a persistent perforation after PPM. The rate of persistent perforation with short-term tubes and long-term tubes was significantly different (6.6% and 20% respectively). Patient characteristics significantly associated with persistent perforations were: age at time of tube removal and number of tubes that patient received. Ear drum characteristics that significantly impacted persistent perforation included: size of ear drum perforation, and presence of tympanosclerosis. Length of intubation, ear drum atrophy, retraction, granulation tissue, middle ear effusion and thickened ear drum were not found to be significant factors.
Conclusion:
Overall, we found an 87% perforation closure rate after surgical removal of the TT and PPM. Persistent perforations occurred significantly more often in patients with long-term tubes than short term tubes. Our data also suggests that several patient and ear drum characteristics may be important factors that contribute to persistent perforation after tympanostomy tube placement and removal.
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