Lentsch E J, Goudy S, Ganzel T M, Goldman J L, Nissen A J
Department of Surgery, Division of Otolaryngology, University of Louisville School of Medicine, 40292, Louisville, KY, USA.
Int J Pediatr Otorhinolaryngol. 2000 Aug 31;54(2-3):143-8. doi: 10.1016/s0165-5876(00)00371-2.
This study was performed to determine the rate of persistent perforations according to age, tube type and duration of intubation in children who underwent elective tympanostomy tube removal. Our retrospective analysis of hospital and clinic charts included all patients who underwent elective tube removal from July 1995 to December 1997 at our institution. Information from the chart review included patient age at time of tube removal, type of tube removed, duration of intubation, presence of granulation tissue/polyps, and concomitant paper patch placement. The outcome of each surgical removal was determined by examining follow-up clinic charts. A patient was deemed to have a persistent perforation if the eardrum had not adequately healed within 3 months after surgery. Data on 201 patients were gathered. These patients had 273 tube removals. Eleven percent of ears (29/273) had persistent perforations. According to tube type, no perforations (0/48) occurred with Collar Bobbin tubes, 6% (3/50) with Tytan tubes, 7% (3/44) with Duravent tubes, and 22% (16/74) with Paparella II tubes. Three percent (3/101) of tubes in place for <3 years and 15% (26/172) of tubes in place for >3 years showed persistent perforations after removal. Ears with granulation polyps had a 9% (18/203) rate of perforations, whereas those without granulation polyps had a 16% (11/70) rate of perforations. Forty percent (4/10) of ears were treated with paper patches at the time of tube removal showed persistent perforations. Our data indicate that the rate of persistent perforation (11%) after elective tympanostomy tube removal is high. The factors associated with higher rates of persistent perforation (P<0.05) include duration of intubation >3 years prior to removal and the use of long-term Paparella II tubes.
本研究旨在确定在接受择期鼓膜置管移除术的儿童中，根据年龄、导管类型和置管时间，持续性穿孔的发生率。我们对医院和诊所病历进行回顾性分析，纳入了1995年7月至1997年12月在我院接受择期导管移除术的所有患者。病历审查获得的信息包括导管移除时的患者年龄、移除的导管类型、置管时间、肉芽组织/息肉的存在情况以及是否同时放置了纸片。每次手术移除的结果通过检查随访诊所病历确定。如果鼓膜在手术后3个月内未充分愈合，则认为患者存在持续性穿孔。收集了201例患者的数据。这些患者共进行了273次导管移除。11%的耳朵（29/273）存在持续性穿孔。根据导管类型，Collar Bobbin导管无穿孔（0/48），Tytan导管有6%（3/50）穿孔，Duravent导管有7%（3/44）穿孔，Paparella II导管有22%（16/74）穿孔。置管<3年的导管中有3%（3/101）在移除后出现持续性穿孔，置管>3年的导管中有15%（26/172）在移除后出现持续性穿孔。有肉芽息肉的耳朵穿孔率为9%（18/203），而无肉芽息肉的耳朵穿孔率为16%（11/70）。在导管移除时接受纸片治疗的耳朵中有40%（4/10）出现持续性穿孔。我们的数据表明，择期鼓膜置管移除术后持续性穿孔的发生率（11%）很高。与较高持续性穿孔率相关的因素（P < 0.05）包括移除前置管时间>3年以及长期使用Paparella II导管。
