Audit of the incidence of persistent perforation of the tympanic membrane following T-tube removal or extrusion

Grommets in otitis media with effusion: the most frequent operation in children. But is it associated with significant complications?

INTRODUCTION

Otitis media with effusion is one of the most frequent diseases in children, and its management requires the attention of general practitioners, pediatricians and ear, nose and throat (ENT) surgeons. The main complications associated with tympanostomy tube insertion, are: (1) purulent otorrhea (10-26% of cases), in which local otic preparations might be effective, and biofilm-resistant tubes may decrease this complication in the future; (2) myringosclerosis (39-65% of operated ears), with usually no serious sequelae; (3) segmental atrophy (16-75% of cases); (4) atrophic scars and pars flaccida retraction pockets (28 and 21% of operated ears, respectively); (5) tympanic membrane perforations (3% of cases, although with T-tubes, the incidence may be as high as 24%); (6) cholesteatoma (1% of cases), although tympanostomy tubes may sometimes prevent, rather than contribute to its development; (7) granulation tissue (5-40% of instances), when the duration of tube retention is prolonged.

CONCLUSION

It would appear that the complications associated with tympanostomy tube insertion are more frequent than anticipated, reaching 80% of operated ears under specific circumstances and in certain subgroups of children. These complications may resolve with conservative management, but in persistent cases surgical removal of the tubes is mandatory.

Prevention of persistent ear drum perforation after long-term ventilation tube treatment for otitis media with effusion in children

The effect of tape patch technique using Steri-Strip tape in combination with freshening of the perforation edge after removal of long-term ventilation tubes for preventing permanent ear drum perforation was evaluated. The longer the tubes remained in place, the higher the incidence of persistent perforation after tube removal. The perforation rate after Goode T-tube treatment was 4.0% in the spontaneous extrusion group and 14.3% in the intentional removal group. In the ears treated by tape patch application, none of the perforations persisted after removal of the Goode T-tube. After removal or extrusion of Paparella Type II tube, perforations did not close in 13.2% of the group without tape patch application. When a tape patch was applied, only one perforation (3.3%) did not close. From these results, tape patch technique in combinations with freshening of the perforation edge at the time of tube removal was useful to promote healing and prevent persistent ear drum perforation.

Long-term follow-up of children inserted with T-tubes as a primary procedure for otitis media with effusion

This study reviews 90 children who underwent T-tube insertion as a primary procedure for otitis media with effusion over a 3-year period and compares the long-term results with a similar group, matched in terms of age, treated with conventional Shepard grommets during the same period. Fifty-one patients (102 ears) in the T-tube group and 53 patients (106 ears) in the Shepherd grommet group attended for clinical review, a minimum of 6 years post-surgery. No significant difference was found between the two groups in terms of pre-operative symptoms (P = 0.95), operative findings (P = 0.84), hearing loss (P = 0.75), or degree of retraction or tympanosclerosis of the tympanic membrane (P = 0.80). A perforation rate of 24% in the T-tube group, compared with 2% in the Shepard grommet group (P = 0.001) is directly attributable to T-tube insertion. Furthermore, the risk of perforation was related to the duration of the ventilation tube in the tympanic membrane.

Long-term ventilation of the middle ear using a tympanotomy technique

The technique of long-term middle ear ventilation using a tympanotomy technique is presented. This has proved successful in the management of persistent middle ear effusion despite numerous previous short- and intermediate-term tympanic membrane ventilation tubes. The technique is particularly appropriate in the presence of severe tympanosclerosis as a result of previous tympanostomy tubes, posterior tympanic membrane collapse and adhesion, and atelectasis.