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Should They Be Removed at 2 Years?

Mohamed A. El-Bitar, MD; Maria T. Pena, MD; Sukgi S. Choi, MD; George H. Zalzal, MD

Arch Otolaryngol Head Neck Surg. 2002;128:1357-1360.

Objectives  To assess the complications of ventilation tubes that were retained in children for 2 years or longer and the necessity of removal.

Design  A retrospective chart review of all patients who underwent ventilation tube removal from 1997 to 2000, with the exclusion of patients with craniofacial anomalies.

Setting  A tertiary children's hospital.

Patients  One hundred twenty-six children with ventilation tubes that were retained for 2 years or longer.

Interventions  Ventilation tube removal and tympanic membrane (TM) patching.

Main Outcome Measures  Otorrhea, formation of granulation tissue, TM perforation, development of cholesteatomas, and tube reinsertion.

Results  A total of 126 patients aged 2 to 14 years (59 girls and 67 boys) underwent removal of their ventilation tubes after 2 years or more. The patients were divided into 2 groups. Group 1 included 67 patients (29 girls and 38 boys) who were younger than 7 years at the time of tube removal. The tubes were retained for 2 to 5 years (mean retention time, 3.3 years). Group 2 included 59 patients (30 girls and 29 boys) aged 7 years and older at the time of tube removal. The tubes were retained for 2 to 10 years (mean retention time, 4.2 years). Complications such as otorrhea, formation of granulation tissue, and TM perforation were seen in 10.3%, 13.8%, and 5.2% of the patients with tube retention of 2 to 3 years, compared with 40.0%, 40.0%, and 46.7% of patients with tube retention of more than 5 years. In group 1, transient otorrhea, formation of granulation tissue, and TM perforation occurred in 13.4%, 7.4%, and 6.0% of the patients, respectively, after 2 years of tube retention. In group 2, similar complications occurred in 23.7%, 25.4%, and 27.1% of the patients, respectively. Forty-six patients in group 1 underwent TM patching (31 with paper and 15 with absorbable gelatin film, with a success rate of 91.3%; however, 8 patients (11.9%) required tube reinsertion. In group 2, patching of the TM was done in 40 patients (13 with paper, 24 with absorbable gelatin film, and 3 with fat), with a success rate of 67.5%. Tube reinsertion was necessary in 1.7% of the patients in group 2. No cholesteatoma was encountered.

Conclusions  Higher complication rates are seen in children when ventilation tubes are retained longer than 2 years. Children 7 years and older have a higher incidence of complications from the tube retention than children younger than 7 years. Early removal of ventilation tubes in children younger than 7 years of age, when the risk for otitis media is still present, may result in the need for tube reinsertion.

From the Department of Pediatric Otolaryngology–Head and Neck Surgery, Children's National Medical Center, George Washington University, Washington, DC.

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