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Relationship between tympanic membrane perforations and retained ventilation tubes
P T Nichols1, H H Ramadan, M K Wax
1Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown 26506-9200, USA.
Insights
Prolonged ventilation tube retention over 36 months increases tympanic membrane perforation risk. Paper patching during tube removal does not aid healing in pediatric patients.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Medical Device Research
Background:
- Ventilation tubes are commonly used to treat otitis media with effusion.
- Prolonged retention of ventilation tubes can lead to complications.
- The impact of ventilation tube retention duration on tympanic membrane healing requires further investigation.
Purpose of the Study:
- To evaluate the effect of extended ventilation tube dwell time on tympanic membrane healing.
- To assess the effectiveness of patching procedures during ventilation tube removal.
Main Methods:
- Retrospective chart review of 76 pediatric patients (99 ears) with ventilation tubes retained for prolonged periods or complicated infections.
- Data collected included retention time, patching use, and surgical outcomes.
- Minimum 6-month follow-up was required.
Main Results:
- Tympanic membrane perforation rates were significantly higher with ventilation tube retention exceeding 36 months (P=.02).
- Previous adenoidectomy was a predictor of poor healing outcomes (47% vs 17%, P=.002).
- Concomitant paper patching at the time of tube removal did not improve healing rates.
Conclusions:
- Ventilation tube retention beyond 36 months is associated with an increased risk of tympanic membrane perforation.
- Paper patching is ineffective in improving healing after ventilation tube removal.
- Further prospective research is recommended to validate these findings and explore alternative patching techniques.
Objectives:
To determine the effects of prolonged ventilation tube retention on tympanic membrane healing and the efficacy of patching procedures used concomitantly at the time of tube removal.
Design:
Retrospective chart review.
Setting:
Tertiary referral academic institution.
Patients:
Seventy-six patients aged 12 years and younger, with a total of 99 ears identified from January 1989 to December 1994. All patients underwent ventilation tube removal for prolonged tube retention or infection unresponsive to medical management. A minimum of 6 months of follow-up was required for inclusion.
Intervention:
Ventilation tube removal under general anesthesia, with or without concomitant patching.
Outcome Measures:
All medical charts were reviewed for age, sex, indications for tube removal, tube retention time, type of patch used (if any), type of tube, outcome after removal, other medical problems, and previous surgical history.
Results:
The perforation rate was significantly higher in children with tubes retained beyond 36 months (P=.02). History of previous adenoidectomy predicted poor outcome, with a rate of 47% vs 17% in patients with no such history (P=.002). Patching did not improve healing. No other patient factors significantly influenced the perforation rate.
Conclusions:
Ventilation tube retention longer than 36 months resulted in an increased perforation rate after surgical removal. Paper patching at the time of tube removal does not improve healing. Prospective studies are needed to confirm these findings and to determine the efficacy of other patching techniques.