Surgical indications and outcomes of tympanostomy tube removal

Objective: To evaluate factors affecting perforation heating in children with surgical removal of retained tympanostomy tubes. Methods: We conducted a retrospective chart review of 82 pediatric patients (111 ears) who underwent surgical tube removal at a tertiary care pediatric hospital from 1/1/1999 to 12/31/2001. Patients included 47 mates and 35 females with an age range of 2-15 years (average age, 6.8 years and median, 6 years). The length of intubation ranged from 12 months to 108 months (average, 44.6 months). The indications for removal included: prolonged intubation (61.3%), otorrhea or recurrent infection (21.6%), obstruction (7.2%), tube in middle ear (6.3%), enlarging perforation (2.7%), and in preparation for future cochlear implant surgery (9.9%). Interventions included removal of tympanostomy tubes and techniques for encouraging perforation closure. Seventy-six percent of the ears had a technique used to encourage heating. These techniques included freshen edges (11.8%), Getfoam (R) or Gelfilm (R) (14.1%), Gelfoam (R) and/or Gelfilm (R) with freshened edges (50.6%). The main outcome measure was perforation heating. Chi-square statistical analysis were used to determine the statistical significant of observations. Results: Overall closure rate for all patients available for follow up was 87.0%, regardless of technique used to encourage heating. There was no statistically significant difference between the average intubation time in ears that heated (44 months), versus those with persistent perforation after removal (42 months). There was no statistical significant difference in closure rate based on patient age. When tubes were removed for prolonged intubation, 87.0% closed. If the indication was otorrhea or recurrent infections, 93.0% healed. Conclusions: The overwhelming majority of patients who undergo surgical removal of tubes will show complete tympanic membrane heating independent of technique at time of removal, duration of intubation, patient age, or indication for removal. (c) 2005 Elsevier Ireland Ltd. All rights reserved.