Factors affecting the extrusion rates of ventilation tubes

A survey in which 939 ventilation tubes of 8 different patterns were inserted and reviewed (up to a maximum of 2 1/4 years) is analysed. Various factors determining the rate of extrusion are discussed. The Sheehy Collar Button tube remained functional for a longer period than any of the other tubes included in the survey.

[Diagnosis and therapy of seromucous otitis. Experience with 2766 operations on children]

We compared tympanometric patterns with the type of ear effusion on 1693 ears of children with chronic seromucous otitis. There was no exact agreement between the tympanograms and the viscosity of the middle ear effusion. We inserted ventilating tubes in 943 of 2766 ears with SOM. A tube was only used if there was mucus in the middle ear. In cases of thin fluid we used myringotomy alone. A test to find the best tube is discussed. For a child with SOM the insertion of a ventilation tube is so helpful and complications so rare that in our opinion there is no better way of treatment. The complications are probably related more to the underlying disease than to the ventilation tube.

[Patency of the tympanic tubes]

A middle ear model was used to examine the patency of different tympanostomy tubes. It is concluded that these tubes provide more of a ventilation than a drainage of the tympanum. The patients need not be overcautious with regard to water with which they may come into contact.

Prolonged middle ear ventilation: the right tube in the right place

Premature extrusion of ventilating tubes continues to plague both doctor and patient. Migrating epithelium on the lateral surface of the drum has been identified as the principal cause of tube migration and extrusion. This information dictates insertion of a tube in an area where the migrating forces tend to keep the tube in place instead of encouraging rejection. When optimally placed, tubes specifically designed for long-term ventilation will function four times longer than randomly placed conventional tubes. The long-term ventilating tube in use since 1965 has been further refined. A notch and tab on the tube mate with a new inserter/suction device, and this combination permits precise placement through a small incision without tilting and twisting during insertion. Suction may be applied as desired to clear the lumen as the insertion tool is withdrawn.

A trial of Biolite ventilation tubes in children: is further use warranted?

A prospective controlled pilot study was undertaken in which Biolite (carbon-coated) ventilation tubes were placed in 44 ears and a conventional silicone tube in the contralateral ear. Long-term follow-up of these patients has revealed little difference in the incidence of tube occlusion or early extrusion. In addition, there were several disadvantages noted with the Biolite tubes: incomplete coating of the tube (especially within the lumen), shedding of the Biolite coating over time, "tattooing" of the tympanic membrane, poor otoscopic visibility, and the higher cost of these tubes. Since the Biolite tube has no documented advantages and, actually, several disadvantages, we believe its use in the treatment of middle ear disorders should be discontinued until significant benefits are demonstrated and present deficiencies are corrected.

"How I do it"--otology and neurotology. A specific issue and its solution. Advantages of the T-tube for short and long-term middle ear ventilation

The T-tube has several advantages that should be considered when selecting a ventilation tube. First, it remains in place much longer than the average tube; thus allowing the physician, rather than chance, to determine when the tube should be removed. Second, it can be removed painlessly without an anesthetic when indicated. Third, it does not have the problem of a high post-removal perforation rate such as seen with other long term tubes. Fourth, it can be easily modified to suit the needs of the patient and the physician.

Myringotomy and ventilation tubes: a report of 1,568 ears

We reviewed the records of all patients who had a myringotomy and insertion of a ventilation tube at Otologic Medical Group during a 6-year period; there were 2,266 intubations on 1,568 ears. Uncomplicated serous otitis media was the indication in 1.055 ears; 19% developed brief episodes of otorrhea. Persistent otorrhea necessitated tube removal in 9 ears, all but 2 of which became dry. These 2 patients required mastoid surgery. We conclude that myringotomy and insertion of a ventilation tube in serous otitis media is associated with infrequent complications, and these complications are probably related more to the underlying disease process than to the ventilation tube.