Permanent middle ear aeration: long-term follow-up of transosseous ventilating tubes

A technique for achieving permanent middle ear aeration by inserting a flanged silicone tube (SPAT) through a hole drilled in the external auditory canal was introduced in 1970. Since 1970, we have used the transosseous procedure in 36 patients (11%) of cases that required middle ear ventilation. The average length of time the transosseous SPAT functioned was 51 months (range 0-138). Best results were obtained in patients over 16 years of age, when chronic ear surgery was not performed simultaneously. Transient otorrhea occurred in 23% of cases. Forty-four percent of tubes became blocked and required removal or were extruded. No patient developed facial weakness, middle ear cholesteatoma, or persistent tympanic membrane perforation. In selected cases, the transosseous SPAT provides long-term middle ear aeration without the risk of permanent tympanic membrane perforation.