Cholesteatomas associated with ventilation tube insertion

Objectives: To determine the incidence of cholesteatoma formation associate d with ventilation tube (VT) placement and to identify and analyze the vari ables and risk factors that may predict or predispose to this complication. Design: We reviewed the medical records of 2829 children following VT inser tion between the years 1978 and 1997 to obtain 1- to 20-year follow-up data . Setting: Departments of Otolaryngology-Head and Neck Surgery and outpatient clinics of 2 tertiary referral academic medical centers. Patients: A study population of 2829 children, ranging in age from 1.2 to 1 4 years (5575 ears), underwent a total of 6701 VT placements. Main Outcome Measurer Cholesteatomas were considered a complication of VT p lacement whenever they developed at or near the site of the tube insertion. Results: Cholesteatomas directly attributed to VT placement occurred in 1.1 % of the ears that were operated on. A higher incidence occurred (1) in chi ldren younger than 5 years, (2) when Goode T-tubes were used, (3) in cases with repeated insertions of tubes, (4) with intubation exceeding 12 months, and (5) in cases with frequent postoperative otorrhea. Conclusions: Cholesteatoma formation associated with VT placement occurs in 1.1% of the ears that are operated on, and therefore it should be discusse d with patients or parents prior to surgery. Periodic and long-term. follow -up microscopic examinations of the eardrum should be performed in all pati ents following tubal extrusion or removal, especially in those at high risk for developing a secondary cholesteatoma, to detect this complication as e arly as possible.