[Surgical treatment of secretory otitis media: persistent perforation as a rare complication].
BACKGROUND
The persistent perforation of the ear drum may appear as a complication after spontaneous or instrumental elimination of ventilatory tubes during surgical management of secretory otitis media. According to recent literature data its incidence can vary in an average interval from 0.5 to 3.4% for the short term ventilatory tubes and more than 8.5% for long term ventilatory tubes. This study showed the results of analysis of the incidence and therapy of persistent perforation of the ear drum after elimination of the short term ventilatory tubes during the treatment of secretory otitis media in 1554 children, treated over the period from 1988 to 1997 at the Ward of ORL, Zvezdara Clinical and Hospital Centre in Belgrade.


METHODS
The retrospective analysis of medical documentation showed that 1554 children were surgically treated by short term ventilatory tubes between 1988 and 1997. Bilateral insertion of the ventilatory tubes was performed in 1353 children (Sheppard short term tubes) and unilateral insertion was performed in 201 children. The age of the patients ranged from 9 months to 12 years.


CONCLUSIONS
After 2907 inserted short term ventilatory tubes 25 (0.86%) persistent perforations of the ear drum were diagnosed. The average time of elimination was 6-8 months after tubes insertion. In 3 cases, refreshment of the edges of perforation and silastic sheet placement led to complete closure of ear drum defect. In 16 patients myringoplasty was performed. According to literature data and our clinical experience, the main cause of this complication is the state of the ear drum which is a part of pathophysiological mechanisms in secretory otitis media. The histopathological studies of the ear drum in secretory otitis media confirmed various morphological changes: thickening of the ear drum, subepithelialo oedema, infiltration of submucous space by lymphocytes, macrophages and plasmocytes. Fibrous layer showed irregularly oriented fibroblasts and a high production of fibrous fibres. The interaction among extracellular tissue, cells of the submucous and subepithelial layer and cytokines causes the process of reparation of the ear drum.


CONCLUSIONS
Persistent perforation of the ear drum is a rare complication during surgical treatment of secretory otitis media, but it has its great clinical importance if spontaneous repair does not appear. Depending on the mucosal status, ear discharge, Eustachian tubes function and immunological status or upper respiratory mucosa, myringoplasty is the method of therapeutical choice.
Sanković
S
S
Ward of Oto-Rhino-Laryngology Clinic, Zvezdara Clinical and Hospital Centre, Belgrade.
Dergenc
R
R
D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008876:Middle Ear Ventilation; D010034:Otitis Media with Effusion / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D018058:Tympanic Membrane Perforation / Q000209:etiology*
Hirursko lecenje sekrecionog otitisa medije: trajna perforacija kao retka komplikacija.