Long‐term middle ear ventilation.

Publisher Website
Google Scholar
Abstract
This is a 16 year experience report on the author's wide flange ventilation tube, used for permanent or severe chronic Eustachian tube dysfunction. Two hundred and twenty‐eight implants in 198 ears of 126 patients were adequately followed. A small series of 13 Paparella implants is included.Patient age ranges from 6 months to 72 years. Tube longevity up to elective removal averaged 51.2 months (longest — 159 months). Average longevity for tubes removed for uncontrolled complications was 34.6 months (longest — 162 months). Comparable figures for the Paparella tube are 15 and 31 months.There were 249 complications in 228 Per‐Lee tube implants and 12 in 9 Paparella tube implants; 69.6% of Per‐Lee tubes and 100% of Paparella tubes were associated with complication. Per‐Lee tube complications occurred from 1 to 162 months after implantation. The most common was infection (68.6% of all complications). The others included bleeding (10.9%), peritubal drum atrophy (11.7%), extrusion (4.8%), tissue growth into the tube (0.8%), tube migration into the middle ear (1.2%), squamous epithelial invasion (1.2%), and obstruction for other causes (0.8%); 75 infections and 8 bleeding episodes required tube removal. The drum did not heal in 14 and 2 cases respectively. Peritubal drum atrophy, an important complication, occurred 29 times and led to 14 unhealed perforations; 12 tubes (5%) extruded leaving 4 drums unhealed. Squamous epithelium invaded the middle ear three times; in one instance it was due to the tube. A total of 49 permanent perforations (24.8% of 198 ears) occurred including those remaining after elective tube removal. This compares with a 2% or less incidence with a grommet and other standard tubes. Since long‐term ventilation is sought, this outcome is less serious than one suspects. Follow‐up hearing data was available for 7 unhealed and 32 healed drums. For unhealed drums (mostly anterior perforations) the average SRT was 7.1 db. The average SRT for healed drums was 11 1b. Other approaches to long‐term ventilation are discussed, specifically Wright's Eustachian tube prosthesis and laser myringotomy. Both approaches seem unreliable. If permanent ventilation is desired, a permanent perforation resulting from a long‐term ventilation tube would seem to be an acceptable result.

This publication has 8 references indexed in Scilit: