Pediatric Tympanostomy Tube Removal Technique and Effect on Rate of Persistent Tympanic Membrane Perforation.

Abstract

Tympanostomy tube removal is a commonly performed pediatric procedure. Few studies have evaluated whether removal technique influences the likelihood of the tympanic membrane (TM) to heal. To determine whether the technique used for tympanostomy tube removal affects the likelihood of persistent TM perforation healing in children. Retrospective case series with medical chart review in a tertiary care pediatric health system of 247 children undergoing tympanostomy tube removal (341 ears) between 2010 and 2013 by 1 of 4 different techniques: (1) tube removal only; (2) freshening TM perforation edges; (3) performing patch myringoplasty; or (4) both freshening edges and performing patch myringoplasty. Rate of persistent TM perforation after tympanostomy tube removal using the different removal techniques. Secondary outcomes included associations between persistent TM perforation and patient and tympanostomy tube characteristics. The overall persistent TM perforation rate was 10% (34 of 341 ears). Tube removal technique did not significantly influence likelihood for the TM to heal: perforations persisted in 11 of 97 ears (11%) with tube removal only, 6 of 68 ears (9%) with freshened TM perforation edges, 7 of 57 (12%) with patch myringoplasty, and 10 of 119 (8%) with both edges freshened and patch myringoplasty (P = .81). The mean (SD) age of patients with a persistent perforation at the time of tympanostomy tube removal was 8.5 (3.9) years vs 6.5 (3.2) years for those without a persistent perforation (P = .01). In patients with trisomy 21, there was a significantly higher rate of persistent TM perforation (OR, 8.65; 95% CI, 2.13-34.74; P = .002). Short-acting tubes were found to have a significantly lower rate of persistent TM perforation (13 of 194; 7%) than longer-acting tubes (9 of 41; 22%) (OR, 0.26; 95% CI, 0.09-0.71; P = .002). No reduction in persistent TM perforation rate was found following tympanostomy tube removal if TM edges were freshened and/or a patch myringoplasty was performed. Increased pediatric age, longer-acting tympanostomy tubes, and history of trisomy 21 may negatively influence likelihood of closure.