MYRINGOTOMY AND VENTILATION TUBE INSERTION - A 10-YEAR FOLLOW-UP

Eighty children who had myringotomy performed for otitis media with ef fusion in 1984 were reviewed in 1994. This had involved surgery on 158 ears. Three aspects of ear condition were studied: hearing loss, tymp anic membrane perforation, and tympanosclerosis. Hearing losses were p resent in 13 ears (8.2 per cent), involving 10 children (12.5 per cent ), although losses were under 20 dB in seven of these ears (five patie nts). Of the six ears with losses more than 20 dB (3.8 per cent), in f ive patients bilateral losses of 30 dB were due to a recurrence of eff usions, a large dry posterior perforation was the cause of a 30 dB los s, an infected anterior perforation had caused a 30 dB loss, an ear wh ich had a cholesteatoma, and had a mastoidectomy and ossiculoplasty in 1987, had a 30-40 dB loss, and one ear which had a Type I tympanoplas ty in 1994 had a 50 dB loss. Therefore in only three ears (1.9 per cen t:) could hearing loss be associated directly with myringotomy and ven tilation tube insertion. Perforations had persisted unilaterally in se ven patients, three having had tympanoplasties. Of the remaining perfo rated tympanic membranes, two were free of symptoms, one had only a sl ight hearing loss, and one had a more significant loss with recurrent infection. Tympanosclerosis was only found in those ears which had ven tilation tubes inserted (and not those which had myringotomy only), oc curring in 48 ears (31 per cent, or 39 per cent of those which had a v entilation tube inserted). There was no link between tympanosclerosis and hearing loss. The site of tympanosclerosis was not restricted to t he site of myringotomy, and in many cases was present only in other ar eas of the tympanic membrane. There was a tendency for more extensive tympanosclerosis to occur in those ears which had more ventilation tub e insertions. The risk of perforation in particular lends support to a policy of 'watchful waiting'.