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Assessing Complication Risk of Pressure Equalizing Tube Placement in Children With Velocardiofacial Syndrome (22q11.2
Nicole Kloosterman1, Michael H Freeman2, Ryan H Belcher2,3
1Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
Insights
Patients with velocardiofacial syndrome (VCFS) often need multiple sets of pressure-equalizing (PE) tubes. These patients face a significantly higher risk of complications requiring further ear surgery, such as myringoplasty or tympanoplasty.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Genetics
Background:
- Persistent tympanic membrane perforations can arise from pressure-equalizing (PE) tube insertions, potentially leading to hearing loss and otorrhea.
- Velocardiofacial syndrome (VCFS) patients frequently require prolonged PE tube use, increasing the likelihood of subsequent otologic interventions.
Purpose of the Study:
- To determine the rates of post-PE tube complications necessitating myringoplasty or tympanoplasty in patients with VCFS.
- To compare surgical intervention rates between VCFS patients with and without cleft palate.
Main Methods:
- A retrospective review of VCFS patients who underwent PE tube placement between 2000 and 2020 at a single children's hospital.
- Assessment of the number of PE tube insertions and subsequent otologic surgeries performed.
Main Results:
- Out of 212 VCFS patients, 66 (31%) received PE tubes, with 46 (70%) requiring two or more sets.
- 19.7% of patients needed additional otologic surgery, including myringoplasty (9.5%) and tympanoplasty (13.6%).
- No significant difference in surgical rates was observed between VCFS patients with or without cleft palate.
Conclusions:
- VCFS patients requiring PE tubes often need multiple insertions and have a substantially elevated risk of complications requiring further surgery.
- Counseling for PE tube placement in VCFS patients should address the increased risk of complications and manage expectations for surgical outcomes.
Introduction:
Persistent tympanic membrane perforation is a known complication of pressure-equalizing (PE) tube insertion. Conductive hearing loss and otorrhea can necessitate surgical repair of these perforations. Long-term tympanostomy tube placement can increase the risk of these complications. Patients with velocardiofacial syndrome (VCFS) typically require prolonged PE tube placement and are thought to have higher risk of requiring additional otologic interventions after PE tube placement. To date, no work has established rates of post-PE tube complications requiring myringoplasty or tympanoplasty in patients with VCFS.
Methods:
A retrospective case review including all patients with VCFS at a single large children's hospital between the years 2000 and 2020 was performed. Number of PE tube insertions required and additional otologic interventions performed were the primary endpoints assessed.
Results:
Of 212 total patients with VCFS, 66 (31%) underwent PE tube placement. Of these children, 46 (70%) required 2 or more sets of PE tubes. A total of 53 patients (80.3%) required no otologic interventions apart from PE tube insertions. Of the 13 patients (19.7%) requiring additional otologic surgery, 6 (9.5%) underwent myringoplasty, and 9 patients (13.6%) required tympanoplasty. There was no significant difference in tympanoplasty (P > 1), myringoplasty (P > 1), or other surgical intervention rates (P = .7464) between VCFS patients with any type of cleft palate versus those with anatomically normal palates.
Conclusion:
This work suggests that most VCFS patients that require tubes, require at least 2 sets of PE tubes, and that the rate of post-PE tube complications requiring further otologic surgery is an order of magnitude higher than the rate established at this institution. Counseling for PE tube placement in VCFS patients may require specific dialogue regarding the substantially increased risk of complications and effort to build appropriate expectations for surgical outcomes regardless of palatal status.
