Factor-Based Extrusion Timing of Ventilation Tubes in Otitis Media with Effusion: A Survival Analysis

Background and Objectives: Ventilation tube insertion (VTI) is the most commonly performed surgical procedure for otitis media with effusion (OME) in children. While the factors associated with tube extrusion have been investigated, their quantitative impact on the timing of extrusion remains insufficiently characterized. This study aimed to identify independent factors associated with ventilation tube extrusion time and to quantify the magnitude and direction of their effect using survival analysis methodology. Materials and Methods: This retrospective cohort study included 150 patients (262 ears) who underwent VTI with Shepard-type tubes for OME at a tertiary referral center between February 2019 and July 2025. Patient-level variables (age, sex, laterality, allergic rhinitis, secondhand smoke exposure, adenoidectomy, and tonsillectomy) were analyzed per patient (n = 150), while ear-specific variables (effusion type, history of previous VTI, and tube obstruction) were analyzed per ear (n = 262). Univariate and multivariate Cox proportional hazards regression analyses were performed to identify independent factors associated with extrusion time. Kaplan-Meier survival curves with log-rank tests were used to compare median extrusion times between groups. Results: The mean ventilation tube extrusion time was 280.38 ± 99.24 days (9.35 ± 3.30 months). Three independent factors significantly associated with shorter extrusion time were identified in multivariate analysis: tube obstruction during follow-up (HR = 2.629, 95% CI: 1.731-3.993, p < 0.001), history of previous VTI (HR = 2.292, 95% CI: 1.678-3.131, p < 0.001), and serous effusion type compared to glue (HR = 1.914, 95% CI: 1.455-2.517, p < 0.001). Age, sex, laterality, allergic rhinitis, secondhand smoke exposure, adenoidectomy, and tonsillectomy were not significantly associated with extrusion time. Conclusions: History of previous VTI, serous effusion type, and tube obstruction during follow-up were independently associated with shorter ventilation tube extrusion time. Notably, tube obstruction during follow-up, which has not been previously evaluated as a factor associated with extrusion time in survival analyses of tube retention, demonstrated the strongest independent effect on extrusion timing. These findings may assist clinicians in anticipating tube behavior and individualizing postoperative follow-up schedules.