Traumatic perforations are associated with previous tympanostomy tube placement
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Updated: Oct 30, 2025
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Published on: February 16, 2022
Glenn Isaacson1, Brian Reilly2
1Department of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, USA; Department of Pediatrics, Lewis Katz School of Medicine at Temple University, USA.
Insights
Children with prior tympanostomy tube placement are more prone to traumatic eardrum perforations at old tube sites. These perforations are typically smaller and less frequently caused by penetrating injuries.
Area of Science:
- Otolaryngology
- Pediatric Medicine
- Trauma Research
Background:
- Tympanostomy tube placement is common in children.
- Late complications can include persistent perforation, tympanosclerosis, and atrophy.
- Clinical observation suggested a link between healed tube sites and re-perforation after trauma.
Purpose of the Study:
- To investigate if previous tympanostomy tube sites increase the risk of traumatic tympanic membrane perforations in children.
- To compare characteristics of traumatic perforations in children with and without a history of tympanostomy tubes.
Main Methods:
- Retrospective review of computerized records from an academic pediatric otolaryngology practice (2001-2020).
- Identified 33 children with confirmed traumatic tympanic perforations and complete follow-up.
- Case-control study design comparing children with and without prior tympanostomy tube placement.
Main Results:
- 58% of traumatic perforations occurred in children with a history of tympanostomy tubes.
- Perforations in the tube group were more frequently associated with blunt or barotrauma (90%) compared to the non-tube group (46%).
- Old tube sites (antero-inferior/superior quadrants) were the location for 79% of perforations in the tube group, versus 29% in the non-tube group. Perforations were smaller in the tube group (18% vs. 27%).
Conclusions:
- Previous tympanostomy tube placement is associated with a higher incidence of traumatic tympanic membrane perforations.
- These perforations commonly occur at prior tube sites and are often smaller.
- Children with prior tube placement are more likely to experience traumatic perforations from blunt or barotrauma rather than penetrating injuries.
Introduction:
Recognized late complications of tympanostomy tube placement include persistent tympanic perforation, tympanosclerosis, and focal atrophy. Based on clinical experience, we suspected that atrophy at healed tympanostomy tube sites might predispose to re-perforation following trauma.
Methods:
Computerized record review of children seen in an academic pediatric otolaryngology practice from January 2001 to December 2020.
Results:
33 children with confirmed traumatic tympanic perforations and complete follow-up were identified. All perforations were unilateral. 19 of 33 (58%) perforations were in children with tympanostomy tube placement in the past and 14/33 (42%) had never had tubes. 17/19 (90%) traumatic perforations in the tube group were due to blunt or barotrauma rather than penetrating trauma as compared with 6/13 (46%) in the non-tube group (p = 0.0147 by Fisher's exact test). One patient in the non-tube group had an unknown mechanism of injury. 15/19 perforations in the tube groups were in the antero-inferior or antero-superior quadrants (old tube sites) compared to 4/14 in the non-tube group (p = 0.0152). Perforations tended to be larger in the non-tube group (non-tube mean perforation size = 27%/tube group mean = 18%) The median time to re-perforation was 8 years (range 3-15 years). Boys predominated in both perforation groups.
Conclusion:
Traumatic perforations in this series occurred more often in the antero-inferior quadrant (old tube site) in children with previous tympanostomy tube placement. These perforations tended to be smaller and less often resulted from penetrating injuries than in children who had never undergone tube placement.
Level Of Evidence:
3B - individual case-control study.
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