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Avishay Golz, MD; David Goldenberg, MD; Aviram Netzer, MD; Liane M. Westerman, MA; S. Thomas Westerman, MD; Milo Fradis, MD; Henry Z. Joachims, MD

Arch Otolaryngol Head Neck Surg. 1999;125:754-757.

Objectives  To determine the incidence of cholesteatoma formation associated with ventilation tube (VT) placement and to identify and analyze the variables and risk factors that may predict or predispose to this complication.

Design  We reviewed the medical records of 2829 children following VT insertion 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 14 years (5575 ears), underwent a total of 6701 VT placements.

Main Outcome Measure  Cholesteatomas were considered a complication of VT placement 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 children 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 discussed with patients or parents prior to surgery. Periodic and long-term follow-up microscopic examinations of the eardrum should be performed in all patients following tubal extrusion or removal, especially in those at high risk for developing a secondary cholesteatoma, to detect this complication as early as possible.

From the Departments of Otolaryngology–Head and Neck Surgery, Rambam Medical Center (Drs Golz, Goldenberg, Netzer, Westerman, and Joachims and Ms Westerman), Bnai-Zion Medical Center (Dr Fradis), and the Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel.

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