The Role of Tympanostomy Tubes in Surgery for Acquired Retraction Pocket Cholesteatoma

Abstract

Objectives: (1) Determine whether intraoperative tympanostomy tubes (TT) during surgery for acquired retraction pocket cholesteatoma (ARPC) results in improved hearing outcomes or decreased recurrence of ARPC. (2) Determine the need for subsequent TT in children that did not receive TT at initial surgery. Methods: Institutional review board–approved retrospective review of children 4 to 18 years, who underwent primary surgery (tympanoplasty or tympanomastoidectomy) for ARPC at a tertiary care children’s hospital from January 1, 2000, to December 31, 2012. Audiometry, operative reports, office findings, TT, and recurrence data for ARPC were analyzed. The chi-square test was used for statistical analysis. Results: Preoperative Mills staging for extent of cholesteatoma was similar for both groups. A total of 24 patients had TT at initial surgery (TT Group) and 34 patients did not (no TT Group). The average preoperative and postoperative SRT were 23dB and 25dB, respectively, for the TT Group, and 31 dB and 31 dB for the no TT Group. The recurrence rate for ARPC was 29% for the TT Group versus 41% for the no TT Group ( P = .35). Thirty-five percent of patients in the no TT Group required TT at a subsequent surgery. Conclusions: There was no statistical difference in recurrence or audiometric outcomes between patients who underwent TT insertion versus those who did not during initial surgery for ARPC. However, since the incidence of recurrent ARPC was 12% lower when TT were placed, and since the rate of subsequent TT was 35% in the no TT Group, a larger, prospective study of TT at initial surgery for ARPC is needed.