Prolonged Middle Ear Ventilation: The Right Tube in the Right Place

Armstrong, B. W.

doi:10.1177/000348948309200611

Cited by 26 publications

(17 citation statements)

References 8 publications

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“…After removal of cerumen and disinfection with 0.5 per cent iodine solution, an incision is made in the tympanic membrane. Despite previous studies describing the advantages of an anterosuperior incision, 8 we prefer an incision in the posteroinferior quadrant. Fluid is aspirated from the middle ear.…”

Section: Methodsmentioning

confidence: 94%

Medium-term middle ear ventilation with self-manufactured polyethylene T-tubes for the treatment of children with middle ear effusion

et al. 2001

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We present the results of the insertion of self-made polyethylene T-tubes for a period of 15-24 months for the treatment of chronic middle-ear effusion. We compare the outcome of our patients to the reported outcome of patients treated with other commonly used ventilation tubes for either shorter or longer periods of time. In a retrospective review of 603 T-tubes inserted in 306 children up to the age of 12 years, charts were reviewed for age, sex, surgical procedure performed, duration of ventilation and complications. In all cases the indication for surgery was chronic middle-ear effusion. The tubes were electively removed by the authors after 15-24 months of ventilation. Spontaneous extrusion was considered a complication. The mean period of ventilation was 20 months. Post-operative otorrhoea was experienced in 6.6 per cent of ears; 4.8 per cent of tubes extruded spontaneously, whereas 3.15 per cent had to be removed earlier than originally planned; 4.9 per cent of ears were re-ventilated at a later date, and 1.49 per cent of ears developed a persistent perforation. We demonstrate that the outcome of patients treated with our self-manufactured tubes for a period of 15-24 months is, in many respects, better or at least comparable to the reported outcome of patients treated with other commonly used ventilation tubes for either shorter or longer periods of time, and that the many complications associated with the conventional T-tube can be reduced. We suggest that our favourable outcome may be due to the duration of ventilation, which was controlled to be shorter than the conventional long-term T-tubes and longer than that of grommets.

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Section: Methodsmentioning

confidence: 94%

Medium-term middle ear ventilation with self-manufactured polyethylene T-tubes for the treatment of children with middle ear effusion

et al. 2001

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“…By 1959, he had adapted this further, producing the first flanged tube moulded of polypropylene. 39 In 1965, he designed a Teflon tube with a sloping flange which was easier to insert through a smaller incision. Although content with its success, he patented the ''Armstrong V'' in 1981.…”

Section: The Second Eramentioning

confidence: 99%

“…He believes that an incision at any other site will lead to premature extrusion of the tube, whereas ''the right tube in the right place'' will remain in situ for ''two years, and sometimes for six or more''; the ''right tube'' was one of his own designs. 39 Myringotomy became a standard treatment for glue ear, with or without adenoidectomy, and a survey of UK ENT surgeons in 1977 indicated that 50% inserted a grommet following myringotomy. 40 Ninety-one percent of American otolaryngologists found ventilating tubes to be more effective than antibiotics in preventing acute otitis media, and 99.4% of those surveyed were using grommets regularly.…”

Section: The Second Eramentioning

confidence: 99%

The History of Myringotomy and Grommets

2020

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The first recorded myringotomy was in 1649. Astley Cooper presented 2 papers to the Royal Society in 1801, based on his observations that myringotomy could improve hearing. Widespread inappropriate use of the procedure followed, with no benefit to patients; this led to it falling from favor for many decades. Hermann Schwartze reintroduced myringotomy later in the 19th century. It had been realized earlier that the tympanic membrane heals spontaneously, and much experimentation took place in attempting to keep the perforation open. The first described grommet was made of gold foil. Other materials were tried, including Politzer's attempts with rubber. Armstrong's vinyl tube effectively reintroduced grommets into current practice last century. There have been many eponymous variants, but the underlying principle of creating a perforation and maintaining it with a ventilation tube has remained unchanged. Recent studies have cast doubt over the long-term benefits of grommet insertion; is this the end of the third era?

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“…20 What is rarely discussed is the fact that the epithelium constitutes just one of several layers of the tympanic membrane. The postulate has been that a tube placed in the anterosuperior quadrant will stay longer due to the pattern of epithelial migration.…”

Section: Quadrant Of Tube Insertionmentioning

confidence: 99%

Five-year results for use of single-flanged tympanostomy tubes in children

Knutsson

Unge

2007

J. Laryngol. Otol.

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We found that 36.4 per cent of the tubes had extruded within 12 months and 71.0 per cent within 24 months. Results showed that 14.1 per cent of the tubes had been removed because of prolonged retention, with a mean time to removal of 38.9 months. The time to extrusion was longer and the rate of retained tubes was higher than those reported for several other short-term tubes. We found that 4.5 per cent of tube insertions had resulted in a persistent perforation, a higher percentage than previously reported for other tubes intended for short-term use. Within five years of tube insertion, 70.5 per cent of the tympanic membranes had normalised.

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Prolonged Middle Ear Ventilation: The Right Tube in the Right Place

Cited by 26 publications

References 8 publications

Medium-term middle ear ventilation with self-manufactured polyethylene T-tubes for the treatment of children with middle ear effusion

Medium-term middle ear ventilation with self-manufactured polyethylene T-tubes for the treatment of children with middle ear effusion

The History of Myringotomy and Grommets

Five-year results for use of single-flanged tympanostomy tubes in children

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