Tympanostomy tubes, their use, abuse, and cost‐benefit ratio

Abstract

Tympanostomy tubes are employed when middle ear ventilation is indicated, particularly when other forms of treatment have failed. Few other uses have broad acceptance. Any other insertion of a ventilating tube implies abuse, either through error in diagnosis or deliberate misapplication. Hard statistical data relating to abuse are impossible to obtain, but ample illustrations can be cited. The cost-benefit ratio is difficult to assess. Cost of a myringotomy and tube versus the cost of a tympanomastoidectomy was determined in four geographic areas. These figures, however, do not reveal how many ears were spared and how much hearing was conserved by tympanostomy tubes. Informed, diligently aggressive use of tympanostomy tubes offers greater potential to avoid serious middle ear disorders and complications than any other single modality.

Association of tympanostomy tubes with future assistive hearing devices–a population based study

“…Controversy exists regarding the role of TT in pediatric patients with recurrent/persistent middle ear disease. While studies support short term resolution of fluid and improvement of hearing in children with otitis media with effusion [9][10][11], and possibly reduction in episodes of AOM in children with recurrent acute otitis media [12][13][14][15][16], there is also a possibility that the tubes themselves contribute to the development of chronic ear disease and abnormalities of the eardrum [3,[17][18][19]. Prompt insertion of TT does not improve developmental outcomes in children with persistent otitis media with effusion [20,21].…”

Aetiology and treatment of persistent middle-ear effusion

“…Although long-term middle-ear aeration to prevent reoccurrence of MEE has been considered desirable for almost a century and is believed by many to have been assisted greatly by the introduction of modern ventilator tubes (Armstrong, 1968), there are some doubts about the wisdom of some of the criteria employed in their current use (Armstrong and Armstrong, 1979;Buckingham, 1981;Sprinkle, 1981). Because our impression of the results with ventilator tubes in our own patients was encouraging, a prospective trial was carried out in order to clarify this issue (Smyth et al, 1982).…”

Differences between children and adults with otitis media with effusion treated with CO2 laser myringotomy

“…Armstrong and Armstrong, who reintroduced the ventilation tube in the 1950s, regarded a 3-week period of transtympanic ventilation as adequate for OME. 3 Although inserting a ventilation tube is a minor procedure, a major disadvantage associated therewith is the need for general anesthesia in children and complications such as chronic perforation, chronic tympanic granuloma, tympanic membrane atrophy, atelectasis, cholesteatoma, and chronic discharge. 4e6 Laser-assisted myringotomy (LAT) in the human ear was first introduced by Goode in 1982, 7 and coupled to a handheld otoscope by DeRowe and colleagues in 1994 8 ; a flashscanner connected to the otoscope has subsequently made LAT a safer technique.…”