Anterior subannular T-tube for long-term middle ear ventilation during tympanoplasty

Objective: PI technique for providing long-term ventilation of the middle e ar (ME) during tympanoplasty is described, and the results using this techn ique in 20 patients with chronic Eustachian tube dysfunction (ETD) are repo rted. Study Design: This study was a retrospective, nonrandomized case review. Setting: This study was conducted at an otology clinic in a tertiary referr al center. Patients: Twenty consecutive patients who underwent tympanoplasty with ETD, adhesive otitis media, or chronic otitis media with perforation were inclu ded in this study. Intervention: All patients had a subannular T-tube placed anteriorly at the time of tympanoplasty for long-term ventilation of the ME space. Main Outcome Measures: The two main outcome measures were tube position and patency. Preoperative and postoperative hearing levels were also tested in most patients, and any complications were documented. Results: Twenty patients (20 ears) received anterior subannular T-tubes at the time of tympanoplasty. Fourteen females and 6 males were evaluated (med ian age, 36 years; range, 7 to 72 years). All patients had ETD; 7 had adhes ive otitis media, 10 had chronic otitis media, 8 had cholesteatoma, and 2 h ad cleft palate. All patients had conductive hearing loss and previous surg ery. All patients underwent tympanoplasty; 11 had concomitant ossiculoplast y, and 5 had mastoidectomy. Follow-up ranged from 8 to 22 months (mean, 13. 4 months). One patient was lost to followup. One tube extruded after 16 mon ths, Two patients had persistent mild retraction of the tympanic membrane. All other tubes are patent and have not migrated or plugged. There has been no evidence of anterior blunting or ingrowth of epithelium around the tube . Conclusions: Anterior subannular T-tube placement is a simple, safe, and ef fective alternative for long-term ME ventilation in patients in whom standa rd transtympanic sites are not available. At their last follow-up visit, al l but one patient had a patent tube. All MEs were aerated. This technique o ffers the advantage of ease of placement during simultaneous tympanoplasty, mastoidectomy, or ossiculoplasty. Longer follow-up is necessary to confirm these initial findings.