Prevalence of Tympanostomy Tube Placement in Relation to Cleft Width and Type

Effect of Tympanostomy Tube Removal Technique on Surgical Success and Operative Time

OBJECTIVE

Tympanostomy tube removal is a common procedure, the most common complication of which is persistent perforation. Multiple surgical techniques exist. This study seeks to determine whether the technique used affects success rate or surgical time.

METHODS

This was a retrospective cohort study in a tertiary-care children's hospital. Tube removal procedure codes were used to extract charts from 2008 to 2023. Data were collected on surgical technique, success, operative time, indications, and patient factors. Primary outcome measure was surgical success, defined as no residual perforation.

RESULTS

A total of 1562 patient ears were analyzed. Success rate was 95.5% for trichloroacetic acid (TCA) myringoplasty with patch, 86.5% for cold myringoplasty with patch placement (CMwP), 74.7% for cold myringoplasty without patch placement (CMsP), and 73.8% for tube removal alone (TR). TR as compared with CMsP did not show a difference in closure rates (p = 1.0000). CMwP was more likely to be successful than TR (p = 0.0162) or CMsP (p = 0.0117). TCA was more likely to be successful than CMwP (p = 0.0197). Median operative time was 4 min for TR, CMsP, and CMwP and 5 min for TCA. This difference in operative time between the groups was statistically significant (p < 0.001).

CONCLUSION

TCA myringoplasty with patch shows greater surgical success rate than cold myringoplasty with patch, cold myringoplasty without patch, or tube removal alone, but it has a longer operative time. Cold myringoplasty with patch has greater surgical success than cold myringoplasty without patch or tube removal alone.

LEVEL OF EVIDENCE

3 Laryngoscope, 135:2171-2175, 2025.

Determination of Tympanostomy Tube Types for Otitis Media with Effusion in Patients with Cleft Palate: Comparison between Paparella Type 1 and Type 2 Tubes

This study examined the effects of different types of tympanostomy tubes in pediatric patients undergoing cleft palate (CP) surgery in order to provide guidance for the proper insertion of tympanostomy tubes in the management of otitis media with effusion (OME). A total of 101 ears with middle ear effusion in 51 patients with CP were included in this study. Patients underwent palatoplasty and tympanostomy tube surgery at the same time. The type of tube inserted (Paparella type 1 or 2), the severity of CP, and types of palatoplasty surgeries were investigated. All patients were followed up for at least 6 months, and recurrence rates, complications, and reinsertion surgery were evaluated. The rate of OME recurrence after spontaneous tube extrusion was significantly higher in the type 1 group than in the type 2 group (44.3% vs. 19.4%, respectively, p = 0.016). Persistent eardrum perforation was more common in the type 2 group than in the type 1 group (41.9% vs. 12.9%, respectively, p = 0.001). The tube reinsertion rate was higher in the type 1 group than in the type 2 group (22.9% vs. 3.2%, respectively, p = 0.015). The tube reinsertion rate decreased to 8.6% in cases of palatoplasty with Sommerlad's technique, even with type 1 tube insertion, which was not significantly different from the reinsertion rate in the type 2 group (3.7%, p = 0.439). The Paparella type 1 tube would be a better choice in cases of palatoplasty performed using Sommerlad's technique, particularly considering the higher rate of persistent eardrum perforation after extrusion associated with the Paparella type 2 tube. Alternatively, a larger size type 2 tube may be considered in other surgeries to decrease the frequency of recurrence and tube reinsertion.

Relationship between cleft palate width and otitis media

Objectives

To investigate the relationship between cleft width and otitis media (OM) and to determine whether a wide cleft palate (CP) is a risk factor of the incidence, type, amount of middle ear effusion, and prolonged morbidity in OM.

Study Design

Retrospective cohort study.

Methods

Children with CP who underwent palatoplasty between 2014 and 2018 were analyzed. Cleft width was measured at palatoplasty. The incidence of otitis media with effusion (OME) and acute otitis media (AOM), the type and amount of middle ear effusion, and OME duration and age at resolution were assessed in relation to cleft width.

Results

One hundred eighteen children were included. The CP types were Veau I in 16, II in 35, III in 48, and IV in 19 patients. The incidence of OME and AOM before palatoplasty was 83.1% and 49.2%, respectively. Cleft width did not differ significantly between patients with or without OME but was significantly greater in those with, than in those without, AOM (p < .001), in those with mucoid, than in those with serous, effusion (p = .012), and in those with complete, than in those with partial, effusion (p = .01). Regardless of cleft width or type, OME persisted for a median duration of 50 months.

Conclusions

Cleft width was significantly associated with the incidence of AOM and the type and amount of middle ear effusion before palatoplasty. However, it was not significantly related to the incidence, age at resolution, or duration of OME. Regardless of cleft width or type, OM in children with CP requires long-term follow-up. Level of Evidence: 2b.