Timing for Removal of Asymptomatic Long-Term Ventilation Tube in Children

  • Osama G. Abdel-NabyAwadEmail author
Original Article


Otitis media with effusion (OME) is the most frequent illness in children. Surgical treatment options include ventilation tube insertion, adenoidectomy or both. Opinions regarding the risks, benefits and intubation period of ventilation tube insertion vary greatly. To determine the appropriate time for when to remove asymptomatic longterm ventilation T-tubes in children. In this prospective study, we analyzed the results of 120 pediatric patients (6–12 years) (240 ears) with persistent OME; we employed the Goode T-silicone tubes. We intentionally planned to remove the tubes at different time points of the study and divided our patients randomly into four subgroups with 30 patents (60 ears in each) according to the intubation period; group I: intubation for 6 months, group II: intubation for 12 months, group III: intubation for 18 months and group IV: intubation for 24 months. The relationship between intubation period and OME recurrence, the rate of persistent tympanic membrane (TM) perforation, granulation tissue or discharge near the tympanostomy tubes, normalization of Eustachian tube function and change of hearing level was analyzed in each patient group. The χ2 analysis showed that the rate of normalization of ET function was significantly higher when tubes were removed after 12-months of intubation (P = 0.002), the rate of OME recurrence was significantly higher when tubes were removed before 12-months of intubation (P = 0.004), The rate of otorrhea significantly increased after 12-months of intubation, development of granulation around tubes was significantly higher after 18-months of tube insertion. The rate of appearance of permanent TM perforation significantly increased after 18-months from tube insertion (P = 0.008). Adenoidectomy did not significantly influence the recurrence rate of OME or the rate of persistent TM peroration after tube removal. Our present results suggest that the appropriate intubation period for healing OME in children would be at 12–18 months. Also, we can conclude that longterm ventilation tubes are recommended to avoid repeated intubation and to obtain sufficient results, although their performance is not always satisfactory; mainly because of accompanying complications.


Otitis media with effusion Ventilation tube T-Tubes Eustachian tube function test 


  1. 1.
    Kim SH, Hong HJ, Kim HJ (2003) Effect of ventilation tube insertion on the quality of life. Korea J Otolaryngol 46:296–301Google Scholar
  2. 2.
    Lous J, Burton MJ, Felding J, Ovesen T, Rovers M, Williamson I (2010) Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children (review). Cochrane Database Syst Rev 6(10):CD00180Google Scholar
  3. 3.
    Armstrong BW (1954) A new treatment for chronic secretory otitis media. Arch Otolaryngol 59:653–654CrossRefGoogle Scholar
  4. 4.
    Morris MS (1999) Tympanostomy tubes: types, indications, techniques and complications. Otolaryngol Clin North Am 32:385–390CrossRefPubMedGoogle Scholar
  5. 5.
    Klingensmith M, Strauss M, Conner GH (1985) A comparison of retention andcomplication rates of large-bore [Paparella II] and small-bore middle earventilating tubes. Otolaryngol Head Neck Surg 93:322–330PubMedGoogle Scholar
  6. 6.
    Weigel MT, Parker MY, Goldsmith MM, Postma DS, Pillsbury HC (1989) A prospective randomized study of four commonly used tympanostomy tubes. Laryngoscope 99:252–256CrossRefPubMedGoogle Scholar
  7. 7.
    Kristensen S (1992) Spontaneous healing of traumatic tympanic membrane perforations in man: a century of experience. JLO 106:1037–1050CrossRefGoogle Scholar
  8. 8.
    Kay DJ, Nelson M, Rosenfeld RM (2003) Meta-analysis of tympanstomy tube sequelae. Otolaryngol Head Neck Surg 129:759Google Scholar
  9. 9.
    Turner JL (1967) Myringotomy by use of a fixed prosthesis. Laryngoscope 77:524–533PubMedGoogle Scholar
  10. 10.
    Jerger J (1970) Clinical experience with impedance audiometry. Arch Otolaryngol 92:311–324CrossRefPubMedGoogle Scholar
  11. 11.
    Committee on hearing and equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss. American Academy of Otolaryngology-Head and Neck Surgery Foundation Inc. Otolaryngol Head Neck Surg 113:186–188 (1995)Google Scholar
  12. 12.
    Bluestone CD, Paradise JL, Beery QC (1972) Physiology of the Eustachian tube in the pathogenesis and management of middle-ear effusions. Laryngoscope 82:1654–1670CrossRefPubMedGoogle Scholar
  13. 13.
    Jonathan DA (1989) Sonotubometry: its role in childhood glue ear. Clin Otolaryngol 14:151–155CrossRefPubMedGoogle Scholar
  14. 14.
    Kim HS, Chae GH, Kang SH, Bong SG (1997) Adult-onset otitis media with effusion. Korean J Otolaryngol 40:520–524Google Scholar
  15. 15.
    Somefun AO, Adefuye SA, Danfulani MA, Afolabi S, Okeowo PA (2005) Adult onset otitis media with effusion in Lagos. Niger Postgrad Med J 12:73–76PubMedGoogle Scholar
  16. 16.
    Per-Lee JH (1981) Long-term middle ear ventilation. Laryngoscope 91:1063–1073CrossRefPubMedGoogle Scholar
  17. 17.
    Mandel EM, Rockette HE, Bluestone CD, Paradise JL, Nozza RJ (1992) Efficacy of myringotomy with and without tympanostomy tubes for chronic otitis media with effusion. Pediatr Infect Dis J 11:270–277CrossRefPubMedGoogle Scholar
  18. 18.
    Rach GH, Zielhuis GA, Van Baarle PW, Van Den Broek P (1991) The effect of treatment with ventilating tubes on language development in preschool children with otitis media with effusion. Clin Otolaryngol 16:128–132CrossRefPubMedGoogle Scholar
  19. 19.
    Riley DN, Herberger S, McBride G, Law K (1997) Myringotomy and ventilation tube insertion: a 10-year follow-up. J Laryngol Otol 111:257–261PubMedGoogle Scholar
  20. 20.
    Hekkstrom S, Groth A, Jorgensen F, Pettersson A, Ryding M, Uhlen I et al (2011) Ventilation tube treatment: a systematic review of the literature. Otolaryngology 145:383–395Google Scholar
  21. 21.
    Dingle AF, Flood LM, Kumar BU, Hampel S (1993) The mini-grommet and tympanosclerosis: results at 2 years. J Laryngol Otol 107:108–110CrossRefPubMedGoogle Scholar
  22. 22.
    Gordts F, Clement PA, Derde MP (1993) Lens tube versus Donaldson tube: results of a prospective study comparing a new with a conventional ventilation tube. Clin Otolaryngol Allied Sci 18:410–414CrossRefPubMedGoogle Scholar
  23. 23.
    Birk HG, Mravec JJ (1976) Myringostomy for middle ear effusions. Ann Otol Rhinol Laryngol 85:263–267Google Scholar
  24. 24.
    Yaman H, Yilmaz S, Guclu E, Subasi B, Alkan N, Ozturk O (2010) Otitis media with effusion: recurrence after tympanostomy tube extrusion. Int J Pediatr Otorhinolaryngol 74:271–274CrossRefPubMedGoogle Scholar
  25. 25.
    Iwaki E, Saito T, Tsuda G, Sugimoto C, Kimura Y, Takahashi N et al (1998) Timing for removal of tympanic ventilation tube in children. Auris Nasus Larynx 25:361–368CrossRefPubMedGoogle Scholar
  26. 26.
    Silverstein H, Miller GF, Lindeman RC (1966) Eustachian tube dysfunction as a cause for chronic secretory otitis in children. Laryngoscope 76:259–273CrossRefPubMedGoogle Scholar
  27. 27.
    Severeid LR (1972) A longitudinal study of the efficacy of adenoidectomy in children with cleft palate and secretory otitis media. Trans Am Acad Ophthalmol Otol 76:1319–1324Google Scholar
  28. 28.
    Widemar L, Svensson C, Rynnel-Dagss B, Schiratzki H (1985) The effect of adenoidectomy on secretory otitis media: a 2-year controlled prospective study. Clin Otolaryngol 10:345–350CrossRefPubMedGoogle Scholar
  29. 29.
    Maw AR (1983) Chronic otitis media with effusion (glue ear) and adenotonsillectomy: prospective randomised controlled study. Br Med J 287:1586–1588CrossRefGoogle Scholar
  30. 30.
    Bulman CH, Brook SJ, Berry MG (1984) A prospective randomized trial of adenoidectomy vs grommet insertion in the treatment of glue ear. Clin Otolaryngol 9:67–75CrossRefPubMedGoogle Scholar
  31. 31.
    Maw AR, Herod F (1986) Otoscopic, impedance, and audiometric findings in glue ear treated by adenoidectomy and tonsillectomy. Lancet 1:1399–1402CrossRefPubMedGoogle Scholar
  32. 32.
    Gates GA, Avery CA, Prihoda TJ, Cooper JG (1987) Effectiveness of adenoidectomy and tympanostomy tubes in the treatment of chronic otitis media with effusion. N Engl J Med 317:1444–1451CrossRefPubMedGoogle Scholar
  33. 33.
    Maw AR, Parker A (1988) Surgery of the tonsils and adenoids in relation to secretory otitis media in children. Acta Otolaryngol (Stockh) 454:202–207CrossRefGoogle Scholar
  34. 34.
    Austin DF (1989) Adenoidectomy for secretory otitis media. Arch Otolaryngol Head Neck Surg 115:936–939CrossRefPubMedGoogle Scholar
  35. 35.
    Nichols PT, Ramadan HH, Wax MK, Santrock RD (1998) Relationship between tympanic membrane perforations and retained ventilation tubes. Arch Otolaryngol Head Neck Surg 124:417–419CrossRefPubMedGoogle Scholar
  36. 36.
    Lentsch EJ, Goudy S, Ganzel TM, Goldman JL, Nissen AJ (2000) Rate of persistent perforation after elective tympanostomy tube removal in pediatric patients. Int J Pediatr Otorhinolaryngol 54:143–148CrossRefPubMedGoogle Scholar
  37. 37.
    Oberman JP, Derkay CS (2004) Posttympanostomy tube otorrhea. Am J Otolaryngol 25:110–117CrossRefPubMedGoogle Scholar
  38. 38.
    Hawke M, Keene M (1981) Artificial Eustachian tube-induced keratin foreign-body granuloma. Arch Otolaryngol 107:581–583CrossRefPubMedGoogle Scholar
  39. 39.
    Van Heerbeek N, De Saar GM, Mulder JJ (2002) Long-term ventilation tubes: results of 726 insertions. Clin Otolaryngol Allied Sci 27:378–383CrossRefPubMedGoogle Scholar
  40. 40.
    Moon IS, Kwon MO, Park CY et al (2013) When should retained Paparella type I tympanostomy tubes be removed in asymptomatic children? Auris Nasus Larynx 40:150–153CrossRefPubMedGoogle Scholar
  41. 41.
    El-Bitar MA, Pena MT, Choi SS, Zalzal GH (2002) Retained ventilation tubes: should they be removed at 2 years? Arch Otolaryngol Head Neck Surg 128:1357–1360CrossRefPubMedGoogle Scholar
  42. 42.
    Dunlap AM, Schuknecht HF (1947) Closure of perforation of the tympanic membrane. Laryngoscope 57:479–490CrossRefPubMedGoogle Scholar
  43. 43.
    Poulsen G, Tos M (1977) Tubal function in chronic secretory otitis media in children. ORL 39:57–67CrossRefPubMedGoogle Scholar
  44. 44.
    Westergaard O (1970) Tubal function in patients with chronic secretory otitis media. Acta Otolaryngol 263:23–24CrossRefGoogle Scholar
  45. 45.
    Holmquist J (1974) Eustachian tube function in secretory otitis media. Arch Otolaryngol 99:59–61CrossRefPubMedGoogle Scholar
  46. 46.
    Bylander A, Tjernström Ö (1983) Changes in Eustachian tube function with age in children with normal ears. Acta Otolaryngol 96:467–477CrossRefPubMedGoogle Scholar
  47. 47.
    MRC Multicenter Otitis Media Study Group (2003) The role of ventilation tube status in the hearing levels in children managed for bilateral persistent otitis media with effusion. Clin Otolaryngol Allied Sci 28:146–153CrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2015

Authors and Affiliations

  1. 1.Otolaryngology, Head and Neck Surgery DepartmentMinia UniversityMinia CityEgypt

Personalised recommendations