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Pediatric Tympanostomy Tube Removal Technique and Effect on Rate of Persistent Tympanic Membrane Perforation.

AbstractIMPORTANCE:
Tympanostomy tube removal is a commonly performed pediatric procedure. Few studies have evaluated whether removal technique influences the likelihood of the tympanic membrane (TM) to heal.
OBJECTIVE:
To determine whether the technique used for tympanostomy tube removal affects the likelihood of persistent TM perforation healing in children.
DESIGN, SETTING, AND PARTICIPANTS:
Retrospective case series with medical chart review in a tertiary care pediatric health system of 247 children undergoing tympanostomy tube removal (341 ears) between 2010 and 2013 by 1 of 4 different techniques: (1) tube removal only; (2) freshening TM perforation edges; (3) performing patch myringoplasty; or (4) both freshening edges and performing patch myringoplasty.
MAIN OUTCOMES AND MEASURES:
Rate of persistent TM perforation after tympanostomy tube removal using the different removal techniques. Secondary outcomes included associations between persistent TM perforation and patient and tympanostomy tube characteristics.
RESULTS:
The overall persistent TM perforation rate was 10% (34 of 341 ears). Tube removal technique did not significantly influence likelihood for the TM to heal: perforations persisted in 11 of 97 ears (11%) with tube removal only, 6 of 68 ears (9%) with freshened TM perforation edges, 7 of 57 (12%) with patch myringoplasty, and 10 of 119 (8%) with both edges freshened and patch myringoplasty (P = .81). The mean (SD) age of patients with a persistent perforation at the time of tympanostomy tube removal was 8.5 (3.9) years vs 6.5 (3.2) years for those without a persistent perforation (P = .01). In patients with trisomy 21, there was a significantly higher rate of persistent TM perforation (OR, 8.65; 95% CI, 2.13-34.74; P = .002). Short-acting tubes were found to have a significantly lower rate of persistent TM perforation (13 of 194; 7%) than longer-acting tubes (9 of 41; 22%) (OR, 0.26; 95% CI, 0.09-0.71; P = .002).
CONCLUSIONS AND RELEVANCE:
No reduction in persistent TM perforation rate was found following tympanostomy tube removal if TM edges were freshened and/or a patch myringoplasty was performed. Increased pediatric age, longer-acting tympanostomy tubes, and history of trisomy 21 may negatively influence likelihood of closure.
AuthorsNatalie C Vercillo, Li Xie, Nidhi Agrawal, Heather C Nardone
JournalJAMA otolaryngology-- head & neck surgery (JAMA Otolaryngol Head Neck Surg) Vol. 141 Issue 7 Pg. 614-9 (Jul 2015) ISSN: 2168-619X [Electronic] United States
PMID26021450 (Publication Type: Journal Article)
Topics
  • Child
  • Child, Preschool
  • Device Removal (adverse effects, methods)
  • Female
  • Humans
  • Male
  • Middle Ear Ventilation (instrumentation)
  • Myringoplasty (adverse effects)
  • Otitis Media (complications, surgery)
  • Retrospective Studies
  • Risk Factors
  • Tympanic Membrane Perforation (complications, epidemiology, pathology)
  • Wound Healing

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