RELATIONSHIP BETWEEN TYMPANIC MEMBRANE PERFORATIONS AND RETAINED VENTILATION TUBES

Objectives: To determine the effects of prolonged ventilation tube ret ention on tympanic membrane healing and the efficacy of patching proce dures used concomitantly at the time of tube removal. Design: Retrospe ctive chart review. Setting: Tertiary referral academic institution. P atients: Seventy-six patients aged 12 years and younger, with a total Of 99 ears identified from January 1989 to December 1994. All patients underwent ventilation tube removal for prolonged tube retention or in fection unresponsive to medical management. A minimum of 6 months of f ollow-up a as required for inclusion. Intervention: Ventilation tube r emoval under general anesthesia, with or without concomitant patching. Outcome Measures: All medical charts were reviewed for age, sex, indi cations for tube removal, tube retention time, type of patch used (if any), type of tube, outcome after removal, other medical problems, and previous surgical history. Results: The perforation rate was signific antly higher in children with tubes retained beyond 36 months (P=.02). History of previous adenoidectomy predicted poor outcome, with a rate of 47% vs 17% in patients with no such history (P=.002). Patching did not improve healing. No other patient factors significantly influence d the perforation rate. Conclusions: Ventilation tube retention longer than 36 months resulted in an increased perforation rate after surgic al removal. Paper patching at the time of tube removal does not improv e healing. Prospective studies are needed to confirm these findings an d to determine the efficacy of other patching techniques.