Factors affecting the persistence of tympanic membrane perforation developed with the extubation of ventilation tube

Yum, Jin-Ho; Park, Yong Soo; Jeon, Eun-Ju; Kim, Dong-Hyun; Jung, Min Kyo; Lee, Dong-Hee

doi:10.1016/j.ijporl.2007.09.009

Cited by 2 publications

(1 citation statement)

References 17 publications

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“…The definition of the length of time where a TT was considered to be retained varied among the studies. Two studies used a criterion of greater than 2 years, 7,22 one study > 2.5 years, 23 four studies greater than 3 years, 1,24–26 two did not specify 27,28 ; and others simply stated “prolonged retention, 8,13,16,29–32 (seven studies). Most studies mentioned many other criteria for elective tube removal such as granulation tissue, otorrhea, nonfunctional TT, intrusion into middle ear, no infection in the previous year of TT retention, 11 or perforation 33 (Table II).…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review and Meta‐Analysis: Timing of Elective Removal of Tympanostomy Tubes

2021

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Objective(s): Tympanostomy tube (TT) placement is the most common surgical procedure in children. Less than 10% of TT do not self-extrude. This study is a systematic review (SR) on elective TT removal in the pediatric population: timing, perforation rates, and role of simultaneous repair. A PICOTS (population, intervention, comparison, outcome, timing, setting) question was formulated: In pediatric patients who have retained TT, what is the preferred time to elective removal of such tubes, and what are the outcomes in terms of perforation rates? Does an intervention at the time of TT removal improve perforation rates?Study Design: Systematic review and meta-analysis. Methods: We searched four major electronic databases: EMBASE, MEDLINE, CDSR, CCRCT for articles published prior to 02/19/20. EndNote ® was used to gather references, review abstracts, and obtain full text articles. Inclusion criteria were studies reporting patients aged 0 to 18 years undergoing elective TT removal with follow-up greater than 3 months. Exclusion criteria included patients >18 years, duplicate patient series, or case series with fewer than five patients. Articles that were not available in English, not available in full text, and those that only addressed long-acting TT were excluded.Data were pooled and meta-analysis was conducted to examine how timing of TT removal, patching of the tympanic membrane, or any TM intervention at TT removal affected outcomes.Results: A total of 1,064 references were found. We identified 63 unique studies for full text review. Of these, 17 were selected for SR. MINORS (Methodological Index for Nonrandomized Studies) scores were low-revealing high bias among the studies. Reported perforation rates after elective TT removal ranged from 0% to 57%. Four studies had data suitable for comparative metaanalysis, which showed a significant increase in perforation rates after elective removal of TT after 3 years compared to removal prior to 3 years (OR 2.89; CI 1.78-4.69). No difference in perforation rates were identified when TM intervention vs. no intervention at time of TT removal was performed (six studies: OR 1.21; CI 0.71-2.07). No difference in perforation rates was identified when the type of TM intervention was compared, including freshening of TM edges, to patching with various materials (paper, fat, gelfoam ® /gelfilm ® , Trichloroacetic acid) (three studies: OR 1.07; CI 0.52-2.19).Conclusion: From the data reviewed in this SR and meta-analysis, elective TT removal at or prior to 3 years' retention showed decreased perforation rates. However, TM intervention at the time of TT removal was not shown to lower perforation rates. In the absence of tube complications such as granuloma formation, nonfunctional tube, or chronic tube otorrhea, it may be reasonable to wait up to 3 years to electively remove a retained TT.

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Section: Resultsmentioning

confidence: 99%

A Systematic Review and Meta‐Analysis: Timing of Elective Removal of Tympanostomy Tubes

2021

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Risk Factors for Replacement of Tympanostomy Tubes After Surgical Removal for Pediatric Patients

Wie,

Shah,

Allen

et al. 2024

Otolaryngol.--head neck surg.

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ObjectivesEar tube removal and patch myringoplasty are frequently performed. The indication and timing for surgery varies among otolaryngologists. This study identifies risk factors associated with the need for the replacement of tympanostomy tubes after tube removal and myringoplasty.Study DesignCase series with chart review.SettingSingle institution academic otolaryngology practice.MethodsPatients younger than 12 years of age who underwent tympanostomy tube removal and myringoplasty at the University of Rochester Medical Center from March 2011 to September 2019. Patients with tympanostomy tube removal due to chronic otorrhea were excluded.ResultsOne hundred sixty‐one patients (230 ears) met inclusion criteria and had sufficient follow‐up. Myringoplasty success after tube removal was 94.8%. Successful myringoplasty was associated with shorter tube duration (32 months) versus unsuccessful myringoplasty (40 months) (P = .02). Replacement tympanostomy tubes after myringoplasty occurred in 9.6% of ears. There was no difference in average patient age (P = .96) or duration of tubes (P = .74) in patients who required replacement of tympanostomy tubes versus patients who did not require tube replacement. Patients with a cleft abnormality were more likely to require tympanostomy tube replacement (P < .001).ConclusionsMost children do not need tubes replaced after removal. This study identified cleft abnormality as a factor that increased the need for replacement tubes. Longer tube durations of over 3 years negatively impacted myringoplasty success. Tympanostomy tube removal should be considered 2 to 3 years after placement in most patients with longer tube durations considered in children with a repaired cleft palate.

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Factors affecting the persistence of tympanic membrane perforation developed with the extubation of ventilation tube

Cited by 2 publications

References 17 publications

A Systematic Review and Meta‐Analysis: Timing of Elective Removal of Tympanostomy Tubes

A Systematic Review and Meta‐Analysis: Timing of Elective Removal of Tympanostomy Tubes

Risk Factors for Replacement of Tympanostomy Tubes After Surgical Removal for Pediatric Patients

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