Meta-analysis of tympanostomy tube sequelae.
OBJECTIVE
To estimate the incidence of tympanostomy tube sequelae based on systematic review of published case series and randomized studies.


METHODS
English-language MEDLINE search from 1966 through April 1999 with manual reference search of proceedings, articles, reports, and guidelines.


METHODS
Cohort studies with otitis media as the primary indication for tube placement.


METHODS
Two reviewers independently extracted data from 134 articles.


RESULTS
Transient otorrhea occurred in 16% of patients in the postoperative period and later in 26%; recurrent otorrhea occurred in 7.4% of patients and chronic otorrhea in 3.8%. Sequelae of indwelling tubes included obstruction (7% of ears), granulation tissue (5%), premature extrusion (3.9%), and medial displacement (0.5%). Sequelae after tube extrusion included tympanosclerosis (32%), focal atrophy (25%), retraction pocket (3.1%), cholesteatoma (0.7%), and perforation (2.2% with short-term tubes, 16.6% with long-term tubes). Meta-analysis showed that long-term tubes increased the relative risk of perforation by 3.5 (95% CI, 1.5 to 7.1) and cholesteatoma by 2.6 (95% CI, 1.5 to 4.4). Similarly, intubation increased the relative risk of tympanosclerosis by 3.5 (95% CI, 2.6 to 4.9) and focal atrophy by 1.7 (95% CI, 1.1 to 2.7) over nonintubated control ears (baseline tympanosclerosis and atrophy rates of 10% and 14%, respectively).


CONCLUSIONS
Sequelae of tympanostomy tubes are common but are generally transient (otorrhea) or cosmetic (tympanosclerosis, focal atrophy). Nonetheless, the high incidence suggests a need for ongoing otologic surveillance of all patients with indwelling tubes and for a reasonable time period after tube extrusion. Long-term tubes should be used on a selective and individualized basis.
Department of Otolaryngology, SUNY Health Science Center at Brooklyn, Brooklyn, New York, USA.
D J
DJ
Kay
M
M
Nelson
R M
RM
Rosenfeld
D001284:Atrophy / Q000453:epidemiology / Q000473:pathology; D018424:Cholesteatoma, Middle Ear / Q000453:epidemiology; D002908:Chronic Disease; D006801:Humans; D015994:Incidence; D008876:Middle Ear Ventilation / Q000009:adverse effects*; D010034:Otitis Media with Effusion / Q000453:epidemiology / Q000601:surgery*; D011184:Postoperative Period; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D012598:Sclerosis / Q000473:pathology; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000473:pathology; D018058:Tympanic Membrane Perforation / Q000453:epidemiology / Q000517:prevention & control