Persistent Tympanic Membrane Perforation Research Articles

Auto Cartilaginous Tympanoplasty for Tympanic Membrane Defects in Pediatric Otorhinolaryngology: Clinical Outcomes and Hearing Improvement

Chronic otitis media with persistent tympanic membrane perforation remains a challenging issue in pediatric otology. Objective: To examine the outcomes of autocartilaginous tympanoplasty in children with total and subtotal tympanic membrane defects. Methods and materials: Eighteen patients (age range: 3-15 years) underwent surgical treatment using the retroauricular approach. A cartilage graft harvested from the tragus and temporal fascia was utilized for tympanic membrane reconstruction. Results: Postoperative evaluations revealed successful restoration of tympanic membrane integrity in 88.8% of cases and hearing improvement in 94.4% of cases in the long-term follow-up. Auto Cartilaginous tympanoplasty demonstrates promise for enhancing the efficacy of tympanoplasty in pediatric otorhinolaryngology.

Balloon Eustachian Tuboplasty Combined or Not with Myringotomy in Eustachian Tube Dysfunction.

Eustachian tube dysfunction (ETD) is a common disorder causing ear pressure, pain, and hearing loss. Balloon Eustachian tuboplasty (BET) is an emerging technique for dilating the Eustachian tube and treating ETD. Whether adding myringotomy improves BET efficacy is controversial. This retrospective study included 95 ETD patients undergoing BET alone (n = 44) or BET with myringotomy (BET + M; n = 51) between June 2020 and August 2021 at a single medical center. The primary outcome was the change in ETDQ-7 symptom scores from baseline to 6 months after treatment. Secondary outcomes included audiometry, endoscopy, Valsalva maneuver, and complications. The ETDQ-7 scores improved significantly after treatment in both groups (p < 0.001), without significant between-group differences (p = 0.417). No significant differences occurred in the audiometry, endoscopy, and Valsalva results or in most complications between groups. One BET + M patient had a persistent tympanic membrane perforation. Both BET alone and BET + M effectively and safely improved the subjective and objective ETD outcomes. However, adding myringotomy did not further improve the outcomes over BET alone, while it incurred risks such as persistent perforation. BET alone may sufficiently treat ETD without requiring myringotomy in this cohort. Further randomized controlled trials should identify optimal candidates for BET alone versus combined approaches.

Assessing Complication Risk of Pressure Equalizing Tube Placement in Children With Velocardiofacial Syndrome (22q11.2 Deletion Syndrome/DiGeorge Syndrome).

Persistent tympanic membrane perforation is a known complication of pressure-equalizing (PE) tube insertion. Conductive hearing loss and otorrhea can necessitate surgical repair of these perforations. Long-term tympanostomy tube placement can increase the risk of these complications. Patients with velocardiofacial syndrome (VCFS) typically require prolonged PE tube placement and are thought to have higher risk of requiring additional otologic interventions after PE tube placement. To date, no work has established rates of post-PE tube complications requiring myringoplasty or tympanoplasty in patients with VCFS. A retrospective case review including all patients with VCFS at a single large children's hospital between the years 2000 and 2020 was performed. Number of PE tube insertions required and additional otologic interventions performed were the primary endpoints assessed. Of 212 total patients with VCFS, 66 (31%) underwent PE tube placement. Of these children, 46 (70%) required 2 or more sets of PE tubes. A total of 53 patients (80.3%) required no otologic interventions apart from PE tube insertions. Of the 13 patients (19.7%) requiring additional otologic surgery, 6 (9.5%) underwent myringoplasty, and 9 patients (13.6%) required tympanoplasty. There was no significant difference in tympanoplasty (P > 1), myringoplasty (P > 1), or other surgical intervention rates (P = .7464) between VCFS patients with any type of cleft palate versus those with anatomically normal palates. This work suggests that most VCFS patients that require tubes, require at least 2 sets of PE tubes, and that the rate of post-PE tube complications requiring further otologic surgery is an order of magnitude higher than the rate established at this institution. Counseling for PE tube placement in VCFS patients may require specific dialogue regarding the substantially increased risk of complications and effort to build appropriate expectations for surgical outcomes regardless of palatal status.

Profile of Allergic Rhinitis and its Association with Chronic Suppurative Otitis Media

Background: Allergic rhinitis is a growing global public health issue. Complications of allergic rhinitis include sinusitis, nasal polyps, bronchial asthma, and otitis media. Allergic rhinitis causes Eustachian tube dysfunction, which leads to chronic otitis media threefold more often. Chronic suppurative otitis media (CSOM) is marked by persistent tympanic membrane perforation and recurrent or persistent mucopurulent otorrhea. Purposes: This study is to determine the relationship between allergic rhinitis and the prevalence of chronic suppurative otitis media in Dr. M Yunus Bengkulu Hospital during 2019-2020. Methods: This was an observational cross-sectional study. This research is an observational analytical study with a cross-sectional approach. Thirty-three respondents were taken using a simple random sampling method. The SFAR (Score for Allergic Rhinitis) questionnaire was used in this study. Medical record data were used to collect CSOM information. Result: Seventy-five percent of respondents with allergic rhinitis also had chronic suppurative otitis media, while the prevalence of non-chronic suppurative otitis media was 25 percent. The p-value for the chi-square test was 0.031. Conclusion: For 2019-2020, there is a relationship between allergic rhinitis and the prevalence of chronic suppurative otitis media (CSOM) at Dr. M. Yunus Bengkulu Hospital.

Use of Short Term Ventilation Tube in Children Having Chronic Otitis Media with Effusion

Abstract Background: Otitis media with effusion is a collection of fluid inside the middle ear cleft, treatment of this condition include medical and surgical methods. This research goal is to focus and specify the clinical features of OME and the association between the new staging and the postoperative findings after surgery of insertion of ventilation tubes (VTs). Objectives: The objective of the study was to assess postoperative sequelae after VT insertion in children. Patients and Methods: Thirty two children with OME with surgical insertion of short term ventilation tubes were included in this study and followed up for one year. Results: In 22 patients, the fluid aspirated surgically after myringotomy was serous, whereas 10 patients were mucinous; for the patients, 53.12% had recurrence, whereas 46.88% showed no recurrence of OME. Only 6.25% of cases included in this study developed myringosclerosis; no otorrhea was reported during the period of the presence of VT in the tympanic membrane, no persistent tympanic membrane perforation after VT auto-extrusion. Conclusion: Even though VT have shown to be very useful in solving conductive hearing loss, its efficacy is a matter of debate in preventing long-term poor effects of the tympanic membrane and delayed onset of hearing loss. Even though ventilation tubes have shown to be very useful in solving the problem of conductive hearing loss.

Intratympanic corticosteroids for sudden sensorineural hearing loss.

Intratympanic corticosteroids for sudden sensorineural hearing loss.

Postero-superior tube in a grooved bone vs. transtympanic tube for middle ear ventilation: a retrospective study comparing outcomes in the Lebanese pediatric population

Background Myringotomy with trans-tympanic T-tube (TTT) placement is the most common surgical procedure performed in children. Finding a technique that provides longer aeration periods, lower complications rates, and less need for subsequent interventions will help the healthcare system from preventable events. Objectives To compare the efficiency and complications rates of the traditional TTT to those of the novel postero-superior tubes in a grooved bone (TGB) for long-term middle ear ventilation in children suffering from recurrent acute otitis media (RAOM), or chronic otitis media with effusion (COME). Methods A total of 200 pretreated ears (96 by TGB and 104 by TTT), were examined after at least 3 years. Data concerning tube condition, and ear outcomes were collected. Pre- and post-operative audiograms were also performed. Results TGB remained in place for longer periods, and it resulted in significantly lower rates of persistent tympanic membrane (TM) perforation (0% vs. 30.8%), TM retraction (14.6% vs. 32.7%), myringosclerosis (12.5% vs. 38.4%), otorrhea (29.2% vs. 52.9%), and need for topical antibiotics (31.3% vs. 51%). It has also resulted in more significant reduction in the air–bone gap on audiograms. Conclusions and significance TGB could be an effective and safe option for middle ear ventilation following COME or RAOM in children.

Tympanic membrane reconstruction of a persistent perforation associated with massive myringosclerosis in a girl with achondroplasia – case report

Achondroplasia is a genetic disease connected with improper function of fibroblast growth factor receptor 3 (FGFR3) resulting in musculoskeletal disorders. Apart from characteristic musculoskeletal abnormalities (short statute with short proximal limb segments, prominent forehead, midface hypoplasia and a depressed nasal bridge) and generalized hypotonia it also affects otolaryngological field in a form of sleep-related upper respiratory tract disorders (obstructive and central apnea) and conductive hearing loss. This is the result of anatomical phenotype, together with Eustachian tube dysfunction. Interestingly, up to 25% of children with achondroplasia may fail hearing screening in one or both ears. In most cases laryngological disorders require surgical procedures, usually adenotomy, adenotonsillectomy, tonsillectomy or tube placement. Such surgical interventions increase the risk of complications, especially when repeated. We would like to present a case of a girl with achondroplasia that was qualified for myringoplasty because of persistent tympanic membrane perforation due to surgical extrusion of persistent ventilation tube, with associated massive myryngoslerosis.

When Should a Retained Tympanostomy Tube be Removed?

When Should a Retained Tympanostomy Tube be Removed?

The impact of tympanic membrane perforations on middle ear transfer function

PurposeInjury or inflammation of the middle ear often results in the persistent tympanic membrane (TM) perforations, leading to conductive hearing loss (HL). However, in some cases the magnitude of HL exceeds that attributable by the TM perforation alone. The aim of the study is to better understand the effects of location and size of TM perforations on the sound transmission properties of the middle ear.MethodsThe middle ear transfer functions (METF) of six human temporal bones (TB) were compared before and after perforating the TM at different locations (anterior or posterior lower quadrant) and to different degrees (1 mm, ¼ of the TM, ½ of the TM, and full ablation). The sound-induced velocity of the stapes footplate was measured using single-point laser-Doppler-vibrometry (LDV). The METF were correlated with a Finite Element (FE) model of the middle ear, in which similar alterations were simulated.ResultsThe measured and calculated METF showed frequency and perforation size dependent losses at all perforation locations. Starting at low frequencies, the loss expanded to higher frequencies with increased perforation size. In direct comparison, posterior TM perforations affected the transmission properties to a larger degree than anterior perforations. The asymmetry of the TM causes the malleus-incus complex to rotate and results in larger deflections in the posterior TM quadrants than in the anterior TM quadrants. Simulations in the FE model with a sealed cavity show that small perforations lead to a decrease in TM rigidity and thus to an increase in oscillation amplitude of the TM mainly above 1 kHz.ConclusionSize and location of TM perforations have a characteristic influence on the METF. The correlation of the experimental LDV measurements with an FE model contributes to a better understanding of the pathologic mechanisms of middle-ear diseases. If small perforations with significant HL are observed in daily clinical practice, additional middle ear pathologies should be considered. Further investigations on the loss of TM pretension due to perforations may be informative.

Clinical Factors Associated With the Outcomes of Long-Term Middle Ear Ventilation Tube Insertion in Pediatric Patients.

Ventilation tube (VT) insertion is the most common treatment for otitis media with effusion (OME). However, OME recurrence and persistent tympanic membrane (TM) perforation after VT removal are encountered in a certain percentage of such children. This study was performed to determine the outcomes of children who underwent long-term VT insertion. A total of 326 ears from 192 patients were analyzed. The associations among the patient age, sex, history of OME, history of repeated acute otitis media, placement duration, whether the VT had been removed intentionally or spontaneously, and the outcome (persistent TM perforation or OME recurrence) were analyzed. The outcomes of multiple VT tube insertions were also reviewed. We also analyzed whether or not local or general anesthesia was associated with the early spontaneous extrusion of the VT. The OME recurrence and TM perforation rates were 29% (96/326 sides) and 17% (57/326 sides), respectively, for first insertions. In addition, 96 (29%) sides underwent ≥2 insertions. The shorter the duration for which the VT was retained in the middle ear, the more significant the rate of increase in OME recurrence. The OME recurrence was observed more often when VT was spontaneously removed than when intentionally removed. The rate of persistent TM perforation was significantly associated with male sex. Persistent TM perforation was not observed in patients who underwent 4 or 5 insertions. The anesthesia method did not significantly influence the timing of spontaneous extrusion of VT. The retention period of VT should be at least 2 years, and VT removal at the age of 7 might be a viable strategy. Multiple VT insertions are recommended for patients with recurrent OME. Ventilation tube under local anesthesia is an effective option for tolerable children.

Intratympanic injection of dexamethasone for Menires disease. What relief can be expected? A case-series study

Introduction: In patients suffering from Menires disease (MD), after failure of oral medical treatment, intratympanic in-jections (IT) may be achieved, among which, IT with dexamethasone (DXM). IT DXM has been reported to be effective on vestibular symptoms but very few reports focus on auditory symptoms. &lt;br/&gt;&lt;br/&gt;Aim: Here we assessed its efficacy both in vestibular and auditory symptoms.&lt;br/&gt;&lt;br/&gt;Patients and method: Twenty-seven MD patients who suffered from auditory and vestibular symptoms despite previous sys-temic medical treatment, underwent at least one series of five daily consecutive IT DXM. Auditory and vestibular assessment were achieved before IT DXM, and four months afterwards. Patients were ranked according to the vestibular functional level scale of the American Academy of Otolaryngology Head Neck society (1995) at the same periods. A specifically designed qu-estionnaire, focused on auditory symptoms was administered after IT DXM. Comparisons used a Chi-2 test for paired series, with p 0.05 considered significant.&lt;br/&gt;&lt;br/&gt;Results: The vestibular functional level shifted significantly towards lower levels, the median shifting from level 4 to 3. There was no complication but two persistent tympanic membrane perforation. Twelve patients (44.4%) had recurrent symptoms, on average 7 months after IT DXM and required additional treatment. Tonal and speech audiometry did not improve, neither the objective auditory and vestibular assessment. Based on the questionnaire, IT DXM was effective on auditory symptoms, at least on tinnitus in 9 cases (33.3%), mainly by lowering its intensity.&lt;br/&gt;&lt;br/&gt;Conclusion: IT DXM confirmed its capacity to relieve vestibular and auditory symptoms, in particular tinnitus, even though transiently.

Trends in Use and Timing of Intratympanic Corticosteroid Injections for Sudden Sensorineural Hearing Loss.

Oral corticosteroids are treatment mainstays for idiopathic sudden sensorineural hearing loss (SSNHL). Recent studies suggest that intratympanic (IT) steroid injections may be effective as an alternate or adjunctive therapy. We sought to investigate nationwide trends in treatment patterns for SSNHL. Retrospective cross-sectional study. A large nationwide health care claims database spanning 2007 to 2016. Patients with SSNHL were identified from the IBM Watson Health MarketScan Database. Multivariable logistic, linear, and Cox regression were used for demographic- and comorbidity-adjusted analyses. Overall, 19,670 patients were included. Between 2007 and 2016, use of oral corticosteroids alone decreased (83.6% to 64.6%, P < .001), while use of IT corticosteroids alone and combination IT-oral corticosteroids increased (IT only, 7.9% to 15.1%, P = .002; IT-oral, 8.5% to 20.4%, P < .001). During the study period, time to treatment initiation decreased for both administration modalities, though more dramatically for IT corticosteroids (IT, 124.0 to 10.6 days, P < .001; oral, 42.6 to 12.7 days, P < .001). In patients receiving both IT and oral corticosteroids, concurrent first-line use increased (25.2% to 52.8%, P < .001). Repeat injections have also become more common but may raise risk of persistent tympanic membrane perforations (vs no injection; hazard ratio [first injection] = 7.95, 95% CI = 5.54-11.42; hazard ratio [fifth or higher injection] = 17.47, 95% CI = 6.93-44.05). SSNHL management increasingly involves early IT steroids as an alternative or adjunctive option to oral steroids. Use of repeat IT corticosteroid injections has also increased but may raise risk of persistent tympanic membrane perforations and subsequent tympanoplasty. Future decision analysis and cost-effectiveness studies are necessary to identify an optimal care pattern for SSNHL.

Comparative study between fascia lata and temporalis fascia in myringoplasty

BackgroundRepair of a perforated tympanic membrane (myringoplasty) can facilitate normal middle ear function, resist infection, and help re-establish normal hearing. Autogenous graft materials are the most popular graft materials used in myringoplasty because of their easy acceptability by the body. This study is conducted to compare between temporalis fascia graft and fascia lata graft in myringoplasty for patients with tubo-tympanic dry perforation.ResultsA total of 60 patients with persistent dry tympanic membrane perforation were included in our study during the period from January 2018 to May 2020. Patients underwent myringoplasty with temporalis fascia (30 patients as group A) or fascia lata (30 patients as group B). Patients were scheduled for follow-up visits concerning graft status, ear discharge, and audiograms. The mean postoperative air-bone gap in group A was 17.5 ± 4 after 1 month and 8.6 ± 6.9 after 3 months, while in group B, the mean postoperative air-bone gap was 17.6 ± 4.9 after 1 month and 9.4 ± 7.5 after 3 months. There was 90% success in graft uptake in group A, while there was 80% success in group B.ConclusionUsing temporalis fascia is still the best and most trustworthy technique of myringoplasty compared to fascia lata graft. However, fascia lata can be a good alternative to temporalis fascia especially in cases of revision myringoplasty, ears having large perforation, or near-total perforation where the chances of residual perforation are high because of the limited margin of remnant tympanic membrane overlapping the graft.

Factors affecting persistent tympanic membrane perforation after tympanostomy tube removal in children

ObjectivesEvaluate and compare the rates of persistent tympanic membrane (TM) perforations between short-term vs long-term tympanostomy tubes. In addition, to determine which demographic, anatomical, and physical factors affect ear drum healing after tympanostomy tube (TT) removal and simultaneous paper patch myringoplasty (PPM) in children. Study designRetrospective chart review. MethodsCharts were reviewed from the Women and Children's of Buffalo hospital and our pediatric otolaryngology practice electronic medical record. Data was retrieved from patients less than 18 years old who underwent surgical removal of a TT and concomitant PPM between January 2005 and January 2017. Results343 ear drums were studied that underwent tympanostomy tube removal and paper patch myringoplasty. 45/343 (13%) of ears had a persistent perforation after PPM. The rate of persistent perforation with short-term tubes and long-term tubes was significantly different (6.6% and 20% respectively). Patient characteristics significantly associated with persistent perforations were: age at time of tube removal and number of tubes that patient received. Ear drum characteristics that significantly impacted persistent perforation included: size of ear drum perforation, and presence of tympanosclerosis. Length of intubation, ear drum atrophy, retraction, granulation tissue, middle ear effusion and thickened ear drum were not found to be significant factors. ConclusionOverall, we found an 87% perforation closure rate after surgical removal of the TT and PPM. Persistent perforations occurred significantly more often in patients with long-term tubes than short term tubes. Our data also suggests that several patient and ear drum characteristics may be important factors that contribute to persistent perforation after tympanostomy tube placement and removal.

Assessment of the role of otoendoscopy in evaluating Eustachian tube and middle ear status during myringoplasty

ObjectiveTo assess the role of otoendoscopy in evaluating Eustachian tube and middle ear status during myringoplasty.BackgroundEustachian tube function has been the center of focus as a prognostic factor for middle ear surgery success because of its primary role in the middle ear aeration and in the pathogenesis of otitis media. Otoendoscopic evaluation of Eustachian tube allows visualization of the protympanic segment of the Eustachian tube and hidden recesses of the middle ear.Patients and methodsIn this prospective study, patients with a persistent dry central tympanic membrane perforation were operated at Otorhinolaryngology Department of Menoufia University Hospital in the period from March 2017 to February 2019. All patients were divided into two groups: group A included 50 cases that underwent otoendoscopic-assisted microscopic myringoplasty, and group B had 50 cases that underwent microscopic myringoplasty.ResultsThis study included 100 patients, with a mean age of 30.2 years. Overall, 42% of the patients were male and 58% of the patients were female. Otoendoscopic examination of middle ear in group A showed 20% of cases with adhesions and secretions at tympanic orifice of the Eustachian tube opening plus 8% of cases with congested mucosa at middle ear apparatus. The success of graft uptake was 94% in group A and 84% in group B.ConclusionThe result of this study supports the use of otoendoscopy in traditional microscopic myringoplasty. Endoscopy could be utilized efficiently to improve the visibility of the Eustachian tube opening and middle ear apparatus and then dealing with any pathology affecting them.

Temporalis Fascia versus Tragal Mucoperichondrium Graft in Myringoplasty

Background: Chronic suppurative otitis media (CSOM) constitutes a major public health problem in children and adults in the developing world. It is an infection characterized by recurrent middle-ear discharge through a persistent tympanic membrane perforation. Objective: the aim of the present study is to compare the surgical and audiological results of temporalis fascia versus tragal perichondrium in myringoplasty Patient and Methods: a randomized prospective study concerned with 60 patients for whom myringoplasty was done. Patients were randomly assigned into two groups; in the first group temporalis fascia graft was used (30 patient) and tragal perichondrium graft was used in the second group (30 patients). Results: our study included 60 patients, 27 males and 33 females with a range from 19- 45 years. Surgical success rates for the first and second groups are 80% and 73.3%, respectively. There was 10.5 dB improvement in mean hearing threshold in fascia group, compared to 8.16 dB improvement in perichondrium group, giving an average of 9.33 dB improvement in mean hearing threshold of the total series. Conclusions: mean value of gain among temporalis fascia graft group was higher than tragal perichondrium graft group. There was statistically significant difference between the two groups regarding gain and no significant difference in surgical success rate between the two groups.

Long‐term outcomes of cartilage‐buttressed T‐tube tympanoplasty for prolonged middle ear ventilation

To report on the safety and efficacy of cartilage-buttressed T-tube tympanoplasty for long-term middle ear ventilation, specifically by examining duration of tube survival, as well as adverse events associated with prolonged middle ear intubation, including persistent tympanic membrane perforation. Retrospective case series of patients undergoing cartilage-buttressed T-tube tympanoplasty between January 2005 and December 2016 in a tertiary-care neurotology private practice. Patients who underwent cartilage T-tube tympanoplasty with complete pre- and postoperative audiometric data and a minimum follow-up duration of 12 months were analyzed. T-tube survival and adverse events including persistent tympanic membrane perforation were recorded and compared to published data for other long-term middle ear ventilation techniques. The study cohort included 72 cartilage-buttressed T-tube tympanoplasties in 68 patients. Median tube survival was 34 months (range, 2-131 months). Incidence of persistent tympanic membrane perforation (n = 1) was 1.4% CONCLUSIONS: Cartilage-buttressed T-tube tympanoplasty is a safe and effective means of accomplishing long-term middle ear ventilation with a considerably lower rate of persistent tympanic membrane perforation as compared to alternative methods of prolonged middle ear ventilation. 4 Laryngoscope, 129:203-208, 2019.

Grommets (ventilation tubes) for recurrent acute otitis media in children.

Acute suppurative otitis media is one of the most common infectious diseases in childhood. Recurrent acute otitis media is defined for the purposes of this review as either three or more acute infections of the middle ear cleft in a six-month period, or at least four episodes in a year. Strategies for managing the condition include the assessment and modification of risk factors where possible, repeated courses of antibiotics for each new infection, antibiotic prophylaxis and the insertion of ventilation tubes (grommets).To establish whether ventilation tube insertion reduces the frequency of episodes of recurrent acute otitis media and the proportion of children with symptoms of ear disease.We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1 2008), MEDLINE (1950 to 2008), EMBASE (1974 to 2008), CINAHL, mRCT (the metaRegister of Controlled Trials for ongoing/unpublished trials), NRR (National Research Register), LILACs, KoreaMed, IndMed, PakMediNet, Zetoc, ISI Proceedings and Cambridge Scientific Abstracts. Reference lists of articles retrieved from the electronic searches were scanned for further trials. Systematic reviews and other meta-analyses were also searched for and their reference lists scanned. Contact was sought with authors of published trials and other experts in the field. The date of the last search was March 2008.No trials that included a treatment and a control group that met the inclusion criteria were excluded. Abstracts were screened and full text articles of studies that met our inclusion criteria obtained. Two authors independently applied the inclusion criteria. Studies included in the review underwent quality assessment performed independently by all authors adapting the methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions.Data were extracted independently by the authors and synthesised descriptively. Five randomised controlled trials were identified, of which two fulfilled the inclusion criteria.Two studies involving 148 children were included in the review. One of these studies, involving 95 children, showed that ventilation tube insertion leads to a mean reduction of 1.5 episodes of acute otitis media in the first six months after treatment. This study also showed a significant increase in the proportion of children with no episodes of AOM (p < 0.001) in the ventilation tube group. The other included study also found a higher proportion of patients in the ventilation tube group had no episodes of AOM in the six months after intervention, but the difference did not reach statistical significance (p = 0.16).Ventilation tubes have a significant role in maintaining a 'disease-free' state in the first six months after insertion. Further research is required to investigate the effect beyond six months. Clinicians should consider the possible adverse effects of grommet insertion before surgery is undertaken.

Outcomes of tympanoplasty in children with down syndrome

IntroductionThe prevalence of chronic otitis media with effusion (COME), and Eustachian tube dysfunction (ETD) is high in Down syndrome (DS) patients. This often necessitates multiple tympanostomy tube (TT) placements resulting in a higher rate of persistent tympanic membrane (TM) perforation requiring tympanoplasty for repair. ObjectivesTo assess risk factors for persistent perforation and outcomes of tympanoplasty in DS patients. MethodsRetrospective case series of 91 ears in 69 DS patients with TM perforations, who were either observed or underwent tympanoplasty. Clinical features, surgical outcomes, and hearing outcomes were assessed. Results91 ears were evaluated. Sixty perforations were observed, and 31 perforations were repaired. The closure rate was 54.8% for primary surgery, and 70.9% after secondary surgical interventions in the Tympanoplasty Group, compared to 33.0% spontaneous closure rate in the Observation Group (p < 0.001). The only risk factor for failed tympanoplasty repair was persistent COME/ETD (OR 27.2, p = 0.001). In the Observation Group perforations diagnosed at an older age, with >3 TT insertions, and with persistent COME/ETD were less likely to close spontaneously. Patients undergoing tympanoplasty had worse preoperative pure tone averages than those being observed, but significant improvement in air-bone gaps were noted in the Tympanoplasty Group (p = 0.02) post-operatively. Patients were often rehabilitated with hearing aids regardless of intervention (53.3% Observation Group, 48.4% Tympanoplasty Group). ConclusionsPersistent TM perforation in children with Down syndrome was associated with a history of COME/ETD, and multiple prior TT insertions. Tympanoplasty was successful for repair in most patients who underwent surgical intervention, but residual hearing loss was common.