Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Ann Otol Rhinol Laryngol. 2024 Feb;133(2):224-228. doi: 10.1177/00034894231202063. Epub 2023 Sep 30.
Persistent tympanic membrane perforation is a known complication of pressure-equalizing (PE) tube insertion. Conductive hearing loss and otorrhea can necessitate surgical repair of these perforations. Long-term tympanostomy tube placement can increase the risk of these complications. Patients with velocardiofacial syndrome (VCFS) typically require prolonged PE tube placement and are thought to have higher risk of requiring additional otologic interventions after PE tube placement. To date, no work has established rates of post-PE tube complications requiring myringoplasty or tympanoplasty in patients with VCFS.
A retrospective case review including all patients with VCFS at a single large children's hospital between the years 2000 and 2020 was performed. Number of PE tube insertions required and additional otologic interventions performed were the primary endpoints assessed.
Of 212 total patients with VCFS, 66 (31%) underwent PE tube placement. Of these children, 46 (70%) required 2 or more sets of PE tubes. A total of 53 patients (80.3%) required no otologic interventions apart from PE tube insertions. Of the 13 patients (19.7%) requiring additional otologic surgery, 6 (9.5%) underwent myringoplasty, and 9 patients (13.6%) required tympanoplasty. There was no significant difference in tympanoplasty ( > 1), myringoplasty ( > 1), or other surgical intervention rates ( = .7464) between VCFS patients with any type of cleft palate versus those with anatomically normal palates.
This work suggests that most VCFS patients that require tubes, require at least 2 sets of PE tubes, and that the rate of post-PE tube complications requiring further otologic surgery is an order of magnitude higher than the rate established at this institution. Counseling for PE tube placement in VCFS patients may require specific dialogue regarding the substantially increased risk of complications and effort to build appropriate expectations for surgical outcomes regardless of palatal status.
持续的鼓膜穿孔是压力平衡（PE）管插入的已知并发症。传导性听力损失和耳漏可能需要手术修复这些穿孔。长期放置鼓室造口管会增加这些并发症的风险。患有 velocardiofacial 综合征（VCFS）的患者通常需要长时间的 PE 管放置，并且在放置 PE 管后被认为需要额外的耳科干预的风险更高。迄今为止，尚无研究确定 VCFS 患者在放置 PE 管后需要进行鼓膜成形术或鼓室成形术的并发症发生率。
对 2000 年至 2020 年期间在一家大型儿童医院接受 VCFS 治疗的所有患者进行回顾性病例回顾。评估的主要终点是需要进行的 PE 管插入次数和进行的其他耳科干预次数。
在 212 名 VCFS 患者中，有 66 名（31%）接受了 PE 管放置。这些儿童中有 46 名（70%）需要 2 套或更多套 PE 管。共有 53 名（80.3%）患者除了 PE 管插入外，无需进行其他耳科干预。在需要额外耳科手术的 13 名患者（19.7%）中，有 6 名（9.5%）接受了鼓膜成形术，有 9 名（13.6%）接受了鼓室成形术。在 VCFS 患者中，无论腭裂类型如何，行鼓室成形术（>1）、鼓膜成形术（>1）或其他手术干预率（=0.7464）均无显著差异。
这项工作表明，大多数需要管的 VCFS 患者至少需要 2 套 PE 管，并且需要进一步进行耳科手术以治疗 PE 管后并发症的发生率比本机构建立的发生率高一个数量级。在 VCFS 患者中进行 PE 管放置的咨询可能需要针对并发症风险显著增加的具体对话，并努力建立与手术结果相关的适当期望，无论腭状态如何。
