Retaining Ventilation Tubes for Two Years and Longer Recommended for Children
Library: MED
Keywords: CHILDREN TUBES EAR INFECTION PEDIATRIC
Description: Ear, nose, and throat specialists found that children may need repeated ventilation tube insertions or a tube in place for two years or more. In either case, concerns about complications have appeared, especially if a tube is retained for longer than expected. A retrospective study was undertaken to assess the complications of ventilation tubes retained for at least two 2 years and the need to remove them.



Release: Immediate

Contact: Kenneth Satterfield
561-447-5521 (May 9-14, 2002)
703-519-1563
ksatterf@entnet.org

RETAINING VENTILATION TUBES FOR TWO YEARS AND LONGER RECOMMENDED FOR CHILDREN YOUNGER THAN AGE SEVEN

Removal is suggested for those older to avoid unnecessary complications

Boca Raton, FL -- Approximately four of five children get at least one episode of otitis media, or middle ear infection, between six months and three years of age or during another less frequently between age four to seven years. During the past decade, myringotomy and ventilation tube insertion became one of the most common surgeries performed on children to resolve this problem. The increasing number of this procedure has brought attention to the complications associated with ventilation tubes retained for an extended period of time.

Ear, nose, and throat specialists found that children may need repeated ventilation tube insertions or a tube in place for two years or more. In either case, concerns about complications have appeared, especially if a tube is retained for longer than expected. Few reports have been published regarding the need to remove a ventilation tube retained for at least two years, even when it is not causing problems such as persistent otorrhea (ear discharge), granulation tissue, or impending cholesteatoma formation.

A retrospective study was undertaken to assess the complications of ventilation tubes retained for at least two 2 years and the need to remove them. The authors of the study "Retained Ventilation Tubes: Should They Be Removed at 2 Years?" are Mohamed A. El-Bitar, MD, Maria T. Pena, MD, Sukgi S. Choi, MD, FACS, and George H. Zalzal, MD, FACS, all from the Department of Pediatric Otolaryngology -- Head & Neck Surgery, Children's National Medical Center, and the George Washington University, Washington, DC. Their findings are to be presented May 14, 2002, at the Annual Meeting of the American Society of Pediatric Otolaryngologists http://216.205.117.211/aspo/ being held May 13-14, at the Boca Raton Resort and Club, Boca Raton, Florida.

Methodology: A retrospective chart review was performed to identify children who had retained ventilation tubes for a period of at least two years. Records excluded were for children with skull and facial anomalies, leaving 126 patients divided into two groups. Group 1 included patients younger than seven years, while group 2 included patients seven years and older at the time of tube removal. The parameters studied were the duration of tube retention, the occurrence of otorrhea after at least two years of retention, development of granulation tissue and cholesteatoma, and the need for ventilation tube reinsertion. The researchers also examined the benefits of patching the tympanic membrane (TM) at the time of tube removal. All patients were followed up for at least three months post tube removal.

Results: Between 1997 and 2000, 126 patients were found to have at least one ventilation tube retained for two or more years for a total of 166 tubes. None had the tube extrude spontaneously after two years; instead the tube was removed in the operating room for variety of reasons. The patients studied ranged in age between 2.5 and 14 years; 59 females and 67 males.

Group 1, under seven years of age, included 67 patients (29 females, 38 males) who had their tubes retained for two to -- 5.5 years (mean 3.3 years). Transient (short term) otorrhea occurred in 13.4 percent, granulation tissue formed in 7.4 percent, and tube reinsertion was needed in 11.9 percent of the patients. Forty-six had the tympanic membrane patched at the time of tube removal with a success rate of 91.3 percent.

Group 2 (age seven and older) included 59 patients (30 females, 29 males) who had retained tubes for 2 -- 10.5 years (mean 4.2 years). Transient otorrhea was seen in 23.7 percent, granulation tissue in 25.4 percent, and tube reinsertion occurred in 1.7 percent. Tympanic membrane patching was performed on 40 patients with a success rate of 67.5 percent.

No cholesteatoma was detected in any of the patients studied.

Conclusions: The results allow the following assumptions to be made:

Tube retention alone as a risk factor: Regardless of the age of the patient, there was a significant increase in the risk of complications after four years of tube retention. After analysis of complications by age group, it was clear that complications such as otorrhea, granulation tissue formation, and TM perforation were more common among children seven and older.

Otorrhea: This is a well-known complication of ventilation tubes and has been described as transient or short lived, recurrent, and chronic. The otorrhea considered in this series occurred after at least two years of tube retention and was mostly transient. Two patients had chronic ear discharge (1.6 percent) that required tube removal. More otorrhea was seen in patients aged seven years and older. This could have resulted from prolonged tube retention, as more patients in group 2 than group 1 had tube retention for more than 4 years (44.1 percent vs. 13.4 percent).

Granulation tissue formation: This is thought to result from increase in oxygen concentration in the middle ear. The condition may be transient and treated by topical antibiotics and steroids drops or persistent and unresponsive to medical treatment leading to tube removal. In the research series, granulation tissue formation was more common among older patients, especially when the tube was retained for more than four years.

Recommendation: Because children younger than seven years old are more prone to recurrent otitis media than older children, it is suggested that removing the ventilation tube during that period may expose the child to recurrent infections and possible tube reinsertion. However, tube removal is recommended for children seven and older to avoid complications arising from tube retention.