Paparella Type Research Articles

Determination of Tympanostomy Tube Types for Otitis Media with Effusion in Patients with Cleft Palate: Comparison between Paparella Type 1 and Type 2 Tubes.

This study examined the effects of different types of tympanostomy tubes in pediatric patients undergoing cleft palate (CP) surgery in order to provide guidance for the proper insertion of tympanostomy tubes in the management of otitis media with effusion (OME). A total of 101 ears with middle ear effusion in 51 patients with CP were included in this study. Patients underwent palatoplasty and tympanostomy tube surgery at the same time. The type of tube inserted (Paparella type 1 or 2), the severity of CP, and types of palatoplasty surgeries were investigated. All patients were followed up for at least 6 months, and recurrence rates, complications, and reinsertion surgery were evaluated. The rate of OME recurrence after spontaneous tube extrusion was significantly higher in the type 1 group than in the type 2 group (44.3% vs. 19.4%, respectively, p = 0.016). Persistent eardrum perforation was more common in the type 2 group than in the type 1 group (41.9% vs. 12.9%, respectively, p = 0.001). The tube reinsertion rate was higher in the type 1 group than in the type 2 group (22.9% vs. 3.2%, respectively, p = 0.015). The tube reinsertion rate decreased to 8.6% in cases of palatoplasty with Sommerlad's technique, even with type 1 tube insertion, which was not significantly different from the reinsertion rate in the type 2 group (3.7%, p = 0.439). The Paparella type 1 tube would be a better choice in cases of palatoplasty performed using Sommerlad's technique, particularly considering the higher rate of persistent eardrum perforation after extrusion associated with the Paparella type 2 tube. Alternatively, a larger size type 2 tube may be considered in other surgeries to decrease the frequency of recurrence and tube reinsertion.

Analysis of Paparella Type 1 tympanostomy tubes in pediatric patients: A single-center retrospective review

ObjectiveThis study aims to evaluate the demographic characteristics, indications for surgery, clinical follow-up results and complication rates of pediatric patients who have received a Paparella Type 1 tympanostomy tube (TT) insertion. MethodsRetropective review of 816 ears of 442 pediatric patients who received Paparella type 1 tympanostomy tube insertions was performed. The patients' age, indication for surgery, middle ear effusion, time to extrusion and postoperative complications were analyzed retrospectively. Ears operated for chronic otitis media with effusion (COME) and recurrent acute otitis media (RAOM) were included in the study. Ears that underwent tympanostomy tube insertion for middle ear atelectasis and suppurative complications of acute otitis media were excluded from the study. Ears with middle ear effusion mucoid and serous were included. Ears without middle ear effusion or with purulent effusion were excluded from the study. Patients with a cleft palate, Down syndrome, craniofacial anomalies and those without regular follow-up until their tubes were extruded, were excluded from the study. ResultsThe mean age of surgery was 5.11 years. 54.3 % of the patients were male and 45.7 % were female. 734 (90 %) tube insertions were performed for patients with COME and 82 (10 %) for those with RAOM. Mucoid middle ear effusion was observed in 86.9 % and serous in 13.1 %. The mean extrusion time of the tubes was 7.16 months. 93.1 % of the tubes were extruded spontaneously within 1 year and 99.9 % within 2 years. Postoperative complications of patients that were included were 8.7 % with otorrhea, 7.7 % premature extrusion, 8.2 % tube occlusion, 0.2 % displacement into the middle ear, 8.2 % tympanic membrane changes (5.4 % sclerosis, 2.3 % retraction and 0.5 % atrophy), 1.2 % permanent perforation, 0.1 % cholesteatoma and 0.1 % retained their tube. Premature extrusion was found to be significantly higher in the RAOM group compared with the COME group (p = 0.042). Tube extrusion time did not affect tympanic membrane changes (p = 0.061). ConclusionsComplication rates after Paparella Type 1 tube insertion are low. The incidence of complications such as otorrhea and tube occlusion were not significantly different between the indication and middle ear effusion groups. Compared to COME group, premature extrusion were found more frequently in the RAOM group. Complications of displacement into the middle ear, permanent perforation, cholesteatoma and retained tube were much rarer.

Factors Affecting the Extrusion Rate and Complications After Ventilation Tube Insertion: A Multicenter Registry Study on the Effectiveness of Ventilation Tube Insertion in Pediatric Patients With Chronic Otitis Media With Effusion-Part II.

The impacts of ventilation tube (VT) type and effusion composition on the VT extrusion rate and complications in children with otitis media remain unclear. This part II study evaluated the factors affecting the extrusion rate, recurrence rate, and complications of VT insertion. A prospective study was conducted between June 2014 and December 2016 (the EVENT study [analysis of the effectiveness of ventilation tube insertion in pediatric patients with chronic otitis media]), with follow-up data collected until the end of 2017. Patients aged <15 years diagnosed with otitis media with effusion who received VT insertion were recruited at 15 tertiary hospitals. The primary outcomes were time to extrusion of VT, time to effusion recurrence, and complications. Data from 401 patients were analyzed. After excluding the. of long-lasting tubes (Paparella type II and T-tubes), silicone tubes (Paparella type I) exhibited a significantly longer extended time to extrusion (mean, 400 days) than titanium tubes (collar-button-type 1.0 mm: mean, 312 days; P<0.001). VT material (hazard ratio [HR], 2.117, 95% confidence interval [CI], 1.254-3.572; P=0.005), age (HR, 3.949; 95% CI, 1.239-12.590; P=0.02), and effusion composition (P=0.005) were significantly associated with the time to recurrence of middle ear effusion. Ears with purulent (mean, 567 days) and glue-like (mean, 588 days) effusions exhibited a shorter time to recurrence than ears with serous (mean, 846 days) or mucoid (mean, 925 days) effusions. The revision VT rates during follow-up were 3.5%, 15.5%, 10.4%, and 38.9% in ears with serous, mucoid, glue-like, and purulent effusions, respectively (P<0.001). The revision surgery rates were higher among patients aged <7 years than among those aged ≥7 years. Silicone tubes (Paparella type I) were less prone to early extrusion than titanium 1.0 mm tubes. VT type, patient age, and effusion composition affected the time to recurrence of effusion.

When Should a Retained Tympanostomy Tube be Removed?

When Should a Retained Tympanostomy Tube be Removed?

A retrospective review of Paparella Type 1 tympanostomy tubes

ObjectiveThis study aims to provide data on ear tube extrusion and complication rates for patients who have Paparella Type 1 tympanostomy tube (TT) placement. MethodsRetrospective chart review of patients 6 months to 12 years old who underwent insertion of Paparella Type 1 TT by a single surgeon. ResultsOf 197 tubes evaluated, 3% were plugged between 1 and 3 months after surgery. Of the 144 tubes evaluated long-term, all tubes extruded within 4 years. There were no tympanic membrane perforations. ConclusionsThis chart review showed expected rate of initial ear tube plugging. The rate of tympanic membrane perforation was lower than expected.

Analysis of factors associated with multiple ventilation tube insertions in children with otitis media with effusion.

To determine the factors related to multiple ventilation tube insertions in children with otitis media with effusion. A retrospective review was performed of 126 ears of 81 children aged less than 12 years who had undergone insertion of a Paparella type 1 ventilation tube for the first time between August 2012 and March 2018. Mean age at the first operation was 4.0 ± 2.2 years, and the mean duration of otitis media with effusion before the first ventilation tube insertion was 5.4 ± 4.5 months. Among 126 ears, 80 (63.5 per cent) had a single ventilation tube insertion and 46 (36.5 per cent) had multiple insertions. On multivariate logistic regression, tympanic membrane retraction, serous middle-ear discharge, and early recurrence of otitis media with effusion were independent predictive factors of multiple ventilation tube insertions. Tympanic membrane retraction, serous middle-ear discharge, and early recurrence of otitis media with effusion after the first tube extrusion are associated with multiple ventilation tube insertions.

When should retained Paparella type I tympanostomy tubes be removed in asymptomatic children?

Tympanostomy tubes are routinely used for the treatment of otitis media with effusion (OME). There is no definite consensus on the optimal length of the intubation period and the timing of tube removal. This study was designed to determine the appropriate time for tympanostomy tube removal in asymptomatic patients of preschool age. A retrospective study was conducted in 336 patients (478 ears) under the age of 7 years old who underwent tympanostomy tube insertion or removal from January 2006 to September 2010 at our institution. The information gathered from chart review included patients' age at the time of tube insertion, duration of intubation, and the presence of complications, such as tube site infection and persistent tympanic membrane perforation. Logistic regression, chi-square test and Fisher's exact test were used to determine the statistical significance of observations. The spontaneous extrusion rate of tympanostomy tubes was about 90% at 18 months and showed a plateau after 18 months. The OME recurrence rate decreased after 12 months of intubation, and complications such as tube site infection and persistent tympanic membrane perforation increased after 15 months of intubation. Tympanostomy tubes removed before 12 months showed a high possibility of recurrence. Removal after 15 months showed an increased possibility of complications. Spontaneous extrusion seldom occurred after 18 months. From these findings, we concluded that asymptomatically retained tympanostomy tubes are recommended to remove when a tube is retained for more than 18 months.

The use of piperacillin–tazobactam coated tympanostomy tubes against ciprofloxacin-resistant Pseudomonas biofilm formation: An in vitro study

Bacterial biofilm formation has been implicated in the high rate of persistent otorrhea after tympanostomy tube insertion. It has been suggested that the tube material may be an important factor in the development of otorrhea. Recently we reported the presence of ciprofloxacin-resistant Pseudomonas aeruginosa (CRPA) biofilms on infected tympanostomy tubes following the use of intractable post-tympanostomy tubes and the onset of otorrhea. In this study, we have evaluated the resistance of piperacillin-tazobactam coated with chitosan on a tympanostomy tube to prevent CRPA biofilm formation in vitro. Three sets each of piperacillin-tazobactam coated silicone tubes (n=5), commercial silver-oxide coated silicone tubes (Activent, Silic) (n=5) and control uncoated tympanostomy tubes (Paparella type 1) (n=5) were processed for evaluation. The piperacillin-tazobactam coated tympanostomy tubes were compared with the silver-oxide coated tubes and the uncoated control tubes for resistance to CRPA biofilm formation after in vitro incubation. Scanning electron microscopy showed that the surface of the silver-oxide coated tube (Activent) formed a thick biofilm with crusts as well as an uncoated tube. In contrast, the surface of a piperacillin-tazobactam coated tympanostomy tube showed virtually no CRPA biofilm formation. The piperacillin-tazobactam coated tympanostomy tube showed resistance to CRPA biofilm formation. The piperacillin-tazobactam coating may be useful to reduce CRPA biofilm formation; however, further in vivo studies are necessary.

長期留置型パパレラＩＩ型チューブの使用経験

The use of long-term middle ear ventilation tubes (Paparella type II) was retrospectively analyzed in 66 ears with otitis media with effusion, in children treated at Kagawa Medical University Hospital between January 1990 and March 1998. The average intubation period was 23.9 months. The average pure tone air conduction threshold showed a remarkable improvement of between 32.7dBHL and 16.9dBHL. Otorrhea was observed in 25 ears (37.8%), obstruction in 2 ears (3.0%), granulation in 3 ears (4.5%) and permanent ear drum perforation in 11 ears (19.6%). No cholesteatma or adhesion of the ear drum was seen. Recurrence of otitis media with effusion was found in 9 of 45 ears (20.0%). In conclusion, Paparella type II tube can be placed for a long-term period and have a low rate of reccurence, but have a high rate of otorrhea and permanent ear drum perforation.

Modification of the inner flange of the Paparella type II ventilation tube for easier insertion

A simple modification of the inner flange of the Paparella type II ventilation tube is described to provide easier and faster insertion. (Otolaryngol Head Neck Surg 1999;121:601-2.)

Timing for removal of tympanic ventilation tube in children

The medical records of 220 ears of 137 pediatric patients (85 male and 52 female) in which three kinds of ventilation tubes were inserted for treating otitis media with effusion (OME) were reviewed. The tubes selected were the Shepard grommet (75 ears), Goode-T (39 ears), and Paparella type II tube (106 ears). The criteria for tube placement were as follows: (1) continuous conductive hearing loss with over 25 dB air-bone gap, (2) resistance to conservative therapy for over 6 months, and (3) retracted and glue-colored tympanic membrane with type B tympanogram. The tubes that remained in place for over 18–24 months were removed intentionally in combination with a freshening of the perforation edge and tape-patch technique using Steri-Strip™ tape (3M) for preventing permanent eardrum perforation, because the incidence of persistent perforation became higher after long-term intubation. Shepard grommets tended to be extruded earlier, while Paparella type II tubes tended to stay longer. The OME recurrence rate decreased 12 months or more after tubal insertion. There was a tendency for the recurrence rate to decrease the longer the tube stayed in the eardrum. The number of recurrences decreased when the patient's age at the tube removal or extrusion was 7–8 years old. Adenoidectomy did not influence the recurrence rate of OME. Although the Goode-T and Paparella tube II tubes showed high perforation rates, the perforation rate after extrusion or removal of the tube was decreased by the use of the tape patch technique in combination with a freshening of the perforation edge. From these findings, it was concluded that the appropriate intubation period for the treatment of OME in children is over 12 months with the use of a long-term tube, and that if the patient's age at the time of tube insertion was below 6 years, it might be better that the removal of the tube is postponed until the patient is 8 years of age.

小児滲出性中耳炎に対する鼓室チューブ留置術の検討

A clinical study of 176 ears with otitis media with effusion in 92 children who had been treated by ventilation tube therapy was conducted at the Kawasaki Medical School Hospital between 1985and 1996. The Goode T-tube was inserted in 86 children, the Paparella type I in 4 children and the Paparella type II in 2 children. The average period of intubation was 11 months. The group in which the tube was removed after over one year showed a recurrence rate of 16%, whereas the recurrence rate for those with the tube inserted for less than one year was 36%. Better results were also noted in those children treated with an adenotomy and tonsillectomy in addition to the ventilation tube therapy. There were many children aged five to seven years old in whom the ventilation tube was removed in the spring or winter, avoid resulted in a poor outcome.

Prevention of persistent ear drum perforation after long-term ventilation tube treatment for otitis media with effusion in children

The effect of tape patch technique using Steri-Strip TM tape in combination with freshening of the perforation edge after removal of long-term ventilation tubes for preventing permanent ear drum perforation was evaluated. The longer the tubes remained in place, the higher the incidence of persistent perforation after tube removal. The perforation rate after Goode T-tube treatment was 4.0% in the spontaneous extrusion group and 14.3% in the intentional removal group. In the ears treated by tape patch application, none of the perforations persisted after removal of the Goode T-tube. After removal or extrusion of Paparella Type II tube, perforations did not close in 13.2% of the group without tape patch application. When a tape patch was applied, only one perforation (3.3%) did not close. From these results, tape patch technique in combination with freshening of the perforation edge at the time of tube removal was useful to promote healing and prevent persistent ear drum perforation.

小児しん出性中耳炎の換気チューブ治療成績

We studied 97 ears of 50 children with otitis media with effusion (OME), undergoing insertion of a long-term ventilation tube between February 1989 and January 1994 in contrast with a previous study of 49 ears of 27 children with OME who were undergone insertion of a short-term ventilation tube. The tubes used for this study included a Butterfly ventilation tube for 78 ears, Shepard grommet for 16 ears and Paparella type I for 3 ears. Simultaneous adenoidectomy was performed on 30 patients. Follow-up examinations consisting of color and retraction of the ear drums, audiometric evaluation such as pure tone audiometry and tympanometry, were scheduled routinely every month. The overall mean follow-up period was 27.9 months. Extrusion occurred after an average of 17.5 months. In April 1994, 46 ears appeared to be effusion-free, however 18 ears developed recurrent OME. The percentage of effusion-free patients in this study was higher than that in the previous study. There was no significant difference between the mean period until extrustion in the effusion-free group and that in the recurrent group.We discussed the relation between OME recurrence and upper respiratory infection after the tube dropped out, as well as complications.

小児における鼓室内チューブ抜去後の鼓膜穿孔

Clinical courses, especially the rate of tympanic membrane perforation were compared in 215 ears of children receiving three kinds of ventilation tubes (Shepard grommet tube, Goode T-tube and Paparella type II tube). The average insertion period was 5.9 months with Shepard tube,10.7 months with T-tube and 15.1 months with Paparella II tube. The average rate of permanent perforation was 0%,7.9% and 15.3%, respectively. The overall incidence of perforation was higher in intensive extraction of the tubes compared with spontaneous extrusion.It was concluded that the incidence of tympanic membrane perforation was higher when the long-term tube was used, when the retention period was prolonged, when infection occurred and when the tube was intensively removed.

Tympanostomy Tube Insertion: Anterosuperior vs. Anteroinferior Quadrant

We studied the extrusion rate of Paparella type I tympanostomy tubes in the anterosuperior quadrant compared to those placed in the anteroinferior quadrant in a prospective study. Thirty-five patients were evaluated. The duration (mean +/- SEM) in the anteroinferior quadrant was 211 +/- 18 days, whereas the duration in the anterosuperior quadrant was 211 +/- 11 days. We conclude that placement in the anterosuperior quadrant does not prolong duration of these tympanostomy tubes.

The prevention of tympanic membrane perforation following the removal of long-term Paparella type II ventilation tubes. Clin. Otolaryngol. 12, 377?381

The prevention of tympanic membrane perforation following the removal of long-term Paparella type II ventilation tubes. Clin. Otolaryngol. 12, 377?381

A Comparison of Retention and Complication Rates of Large‐Bore (Paparella II) and Small‐Bore Middle Ear Ventilating Tubes

Large-bore myringotomy tubes are usually reserved for the treatment of refractory middle ear effusion. Theoretically, they have an extended intubation time and a higher complication rate. There is, however, scant support of this in the literature. The duration of intubation, efficacy, and complication rates of the large-bore Paparella type II tube were compared with Paparella type I, Shepard, and Armstrong tubes. The study included 242 patients with 600 intubations. In addition, a subpopulation of patients receiving their initial intubation during this study was reviewed. Findings were similar for both groups. Paparella type II tubes had a prolonged period of intubation and a decreased reintubation rate when compared with the smaller bore tubes. Larger bore tubes had an increased complication rate when compared with the smaller bore tubes. Complications included occasional or frequent otorrhea and an increased rate of permanent perforation of the tympanic membrane. There was no instance of cholesteatoma formation secondary to intubation. Guidelines are presented for the use of the Paparella type II tube.

Effect of tympanostomy tubes on the pathogenesis of acute otitis media

Intubation of the tympanic membrane as a treatment for acute otitis media is extremely controversial. This study was designed to determine the effect of tympanic membrane intubation in an experimental model for acute purulent otitis media. The right tympanic membrane of the chinchilla was intubated with Paparella Type I tympanostomy tubes. This procedure was followed in seven days by nasopharyngeal inoculation of Streptococcus pneumoniae and in an additional three days by nasopharyngeal inoculation of influenza A virus. Nasopharyngeal inoculation with these microorganisms results in acute purulent otitis media in 70 per cent of animals. The presence of the tympanostomy tubes did not reduce the incidence of clinical otitis media, nor did it reduce the pathologic changes within the middle ear space. The tympanostomy tubes did, however, significantly reduce the incidence and severity of pathologic changes in the subepithelial space of the middle ear mucosa.