Postero-superior tube in a grooved bone vs. transtympanic tube for middle ear ventilation: a retrospective study comparing outcomes in the Lebanese pediatric population

Abstract

Background

Myringotomy with trans-tympanic T-tube (TTT) placement is the most common surgical procedure performed in children. Finding a technique that provides longer aeration periods, lower complications rates, and less need for subsequent interventions will help the healthcare system from preventable events.

Objectives

To compare the efficiency and complications rates of the traditional TTT to those of the novel postero-superior tubes in a grooved bone (TGB) for long-term middle ear ventilation in children suffering from recurrent acute otitis media (RAOM), or chronic otitis media with effusion (COME).

Methods

A total of 200 pretreated ears (96 by TGB and 104 by TTT), were examined after at least 3 years. Data concerning tube condition, and ear outcomes were collected. Pre- and post-operative audiograms were also performed.

Results

TGB remained in place for longer periods, and it resulted in significantly lower rates of persistent tympanic membrane (TM) perforation (0% vs. 30.8%), TM retraction (14.6% vs. 32.7%), myringosclerosis (12.5% vs. 38.4%), otorrhea (29.2% vs. 52.9%), and need for topical antibiotics (31.3% vs. 51%). It has also resulted in more significant reduction in the air–bone gap on audiograms.

Conclusions and significance

TGB could be an effective and safe option for middle ear ventilation following COME or RAOM in children.

Chinese Abstract

背景：经鼓室 T 管 (TTT) 置入的鼓膜切开术是儿童最常见的外科手术。寻找一种能够提供更长的通气时间、更低的并发症发生率和更少需要后续干预的方法将有助于医疗保健系统避免发生可预防的事件。

目的：比较传统 TTT 与新型沟槽骨后上管 (TGB) 对患有复发性急性中耳炎 (RAOM) 或慢性渗出性中耳炎（COME）的儿童进行长期中耳通气的效率和并发症发生率。

方法：至少 3 年后检查了总共 200 只已经治疗的耳朵（96 只耳用了TGB, 104 只耳用了TTT）。收集关于管的状况和耳朵结果的数据。还做了术前和术后听力图。

结果：TGB 保留更长时间, 并导致更低比率的持续性鼓膜 (TM) 穿孔（0% 对 30.8%）、TM 回缩（14.6% 对 32.7%）、鼓膜硬化（12.5% 对. 38.4%)、耳漏 (29.2% vs. 52.9%) 以及需要外用抗生素 (31.3% vs. 51%)。它还导致听力图上的气骨间隙减少更显著。

结论及意义：TGB 可能是儿童 COME 或 RAOM 后中耳通气的一种有效且安全的选择。

Keywords:

• Tube in grooved bone
• chronic otitis media with effusion
• middle ear ventilation
• recurrent acute otitis media
• trans-tympanic T-tube
• tympanic membrane

Acknowledgements

The authors thank all patients who agreed to participate in this study.

Ethics approval and consent to participate

The institutional review board of the Eye and Ear Hospital-International and the Ethics committee at the Saint Joseph Hospital granted permission to carry out the study. Prior to participation, parents approved on the study objectives and signed on behalf of their children an informed clarified consent. Additionally, assent from children over the age of 7 years was also obtained. All methods were performed in accordance with the relevant guidelines and regulations.

Disclosure statement

The authors have nothing to disclose.

Author contributions

EBS involved in the study design, results interpretation and article writing; CM involved in the physical examination of the patients and medical review of the article; AA involved in the study design, data collection, results interpretation, and article writing; SH involved in the statistical analysis, results interpretation, and critical review of the article; BR supervised the project and critically reviewed the paper; all authors reviewed the final manuscript and gave their consent.