Pediatric Tympanostomy Tube Removal: Does Technique Affect the Rate of Persistent Tympanic Membrane Perforation?

Abstract

Objectives: Determine whether various techniques used to promote tympanic membrane (TM) perforation closure at the time of ventilation tube removal impact the likelihood of TM perforation healing in children. Methods: A retrospective chart review was conducted of 265 children (341 ears) who underwent tympanostomy tube removal at a tertiary care pediatric hospital between January 2010 and November 2013. Techniques performed at the time of ventilation tube removal included tube removal only, freshening the perforation edges, performing paper patch myringoplasty, or both freshening edges and paper patch myringoplasty. Results: The persistent TM perforation rate was 9.97% (34/341). Technique was not found to significantly influence the likelihood for the TM to heal ( P = .81), with 11/86 (12.7%) having persistent perforations with tube removal only, 6/62 (9.7%) with freshened perforation edges, 7/50 (14.0%) with paper patch myringoplasty and 10/109 (9.2%) with both edges freshened and paper patch myringoplasty. There was no significant interaction between technique and age, tube retention length, number of previous ventilation tubes placed, or type of tube removed. Additionally, no significant difference in TM perforation rate was observed for number of previous tympanostomy tubes, tube duration, previous adenoidectomy, or indication for tube removal. Factors associated with higher rates of persistent perforation included older age, longer-acting ventilation tubes, and trisomy 21. Conclusions: There is no reduction in persistent TM perforation rate following ventilation tube removal if edges are freshened and/or a paper patch myringoplasty is performed. Increased pediatric age, longer-acting tympanostomy tubes and history of trisomy 21 may negatively influence the likelihood of closure.