Outcomes in children with perforated tympanic membranes after tympanostomy tube placement: results using a pilot treatment algorithm

Schraff, Scott A.; Markham, Jeffrey; Welch, Camille; Darrow, David H.; Derkay, Craig S.

doi:10.1016/j.amjoto.2005.11.007

« Previous Next »American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume 27, Issue 4 , Pages 238-243, July 2006

Outcomes in children with perforated tympanic membranes after tympanostomy tube placement: results using a pilot treatment algorithm

Podium presentation at the 2005 Society for Ear, Nose, and Throat Advances in Children Meeting, December 2-5, 2005, Toronto, Canada.

Scott A. Schraff, MD
- Department of Otolaryngology–Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
Jeffrey Markham, MD
- Department of Otolaryngology–Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
Camille Welch, MPH
- Center for Pediatric Research, The Children's Hospital of the King's Daughters, Norfolk, VA, USA
David H. Darrow, MD
- Department of Otolaryngology–Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
Craig S. Derkay, MD
- Center for Pediatric Research, The Children's Hospital of the King's Daughters, Norfolk, VA, USA
- Corresponding author. Department of Otolaryngology–Head and Neck Surgery, Eastern Virginia Medical School, 825 Fairfax Ave, Suite 510, Norfolk, VA 23507-1914, USA.

Abstract

Purpose

The objective of this study was to examine the success of a pilot treatment algorithm for tympanic membrane perforations in children after tympanostomy tube placement.

Materials and Methods

A retrospective chart review of children with diagnosed tympanic membrane perforations after tympanostomy tube placement from 1998 to 2003 at a tertiary care children's hospital was performed. The patients had been treated according to an algorithm used by 2 pediatric otolaryngologists for management of tympanic membrane perforations: observation vs myringoplasty. Success rates were examined.

Results

Ninety-five children were identified, 27% of whom had nonhealing perforations after tube extrusion; 73% of the perforations were caused by a retained tube. The median duration of tube retention was 48 months, ranging from 13 to 120 months. After the treatment protocol, 76% of the patients underwent gelatin film or paper patch myringoplasty, 23% had adipose myringoplasty, and 1% were observed. Overall, 91% had healed perforations after the first intervention. Among those requiring a second intervention, the sizes of initial perforations were between 15% and 40%, with postrepair perforation sizes between 5% and 40%. In addition, 75% of those requiring a second intervention underwent tympanoplasty repair and 25% had fat patch myringoplasty. None required a third intervention.

Conclusions

Our treatment algorithm for children with tympanic membrane perforations after tympanostomy tube placement appears to be successful and is an excellent model for other clinicians.