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Timing for removal of tympanic ventilation tube in children
Insights
Longer ventilation tube placement for otitis media with effusion (OME) in children over 12 months reduces recurrence. Postponing tube removal until age 8, especially for younger children, further decreases OME recurrence and perforation rates.
Area of Science:
- Otolaryngology
- Pediatric Medicine
- Medical Device Technology
Background:
- Otitis media with effusion (OME) is common in children, often requiring tympanostomy tube insertion.
- OME can lead to conductive hearing loss and speech development delays.
- Previous treatments have varying success rates for OME recurrence.
Purpose of the Study:
- To evaluate the efficacy of different ventilation tube types and durations in treating pediatric OME.
- To assess the impact of tube dwell time and removal timing on OME recurrence and tympanic membrane perforation.
- To compare recurrence rates and perforation incidence among Shepard grommet, Goode-T, and Paparella type II tubes.
Main Methods:
- Retrospective review of 220 ears in 137 pediatric patients treated for OME.
- Analysis of data from patients receiving Shepard grommet, Goode-T, or Paparella type II ventilation tubes.
- Evaluation of criteria including hearing loss, conservative therapy resistance, and tympanogram findings.
Main Results:
- Paparella type II tubes stayed longer than Shepard grommets; Goode-T tubes also had prolonged dwell times.
- OME recurrence decreased with longer tube dwell times (over 12 months).
- The tape-patch technique combined with perforation edge freshening reduced persistent perforation rates.
Conclusions:
- Long-term ventilation tube intubation (over 12 months) is recommended for pediatric OME treatment.
- Delaying tube removal until age 7-8 years, particularly for younger children, is associated with fewer recurrences.
- Appropriate tube selection and management techniques can minimize tympanic membrane perforation.
Abstract:
The medical records of 220 ears of 137 pediatric patients (85 male and 52 female) in which three kinds of ventilation tubes were inserted for treating otitis media with effusion (OME) were reviewed. The tubes selected were the Shepard grommet (75 ears), Goode-T (39 ears), and Paparella type II tube (106 ears). The criteria for tube placement were as follows: (1) continuous conductive hearing loss with over 25 dB air-bone gap, (2) resistance to conservative therapy for over 6 months, and (3) retracted and glue-colored tympanic membrane with type B tympanogram. The tubes that remained in place for over 18-24 months were removed intentionally in combination with a freshening of the perforation edge and tape-patch technique using Steri-Strip tape (3M) for preventing permanent eardrum perforation, because the incidence of persistent perforation became higher after long-term intubation. Shepard grommets tended to be extruded earlier, while Paparella type II tubes tended to stay longer. The OME recurrence rate decreased 12 months or more after tubal insertion. There was a tendency for the recurrence rate to decrease the longer the tube stayed in the eardrum. The number of recurrences decreased when the patient's age at the tube removal or extrusion was 7-8 years old. Adenoidectomy did not influence the recurrence rate of OME. Although the Goode-T and Paparella tube II tubes showed high perforation rates, the perforation rate after extrusion or removal of the tube was decreased by the use of the tape patch technique in combination with a freshening of the perforation edge. From these findings, it was concluded that the appropriate intubation period for the treatment of OME in children is over 12 months with the use of a long-term tube, and that if the patient's age at the time of tube insertion was below 6 years, it might be better that the removal of the tube is postponed until the patient is 8 years of age.