title: Synchronous fat plug myringoplasty and tympanostomy tube removal in the management of refractory otorrhoea in younger patients.
abstract: OBJECTIVE
  Tympanostomy tubes are associated with many complications, the most common being recurrent otorrhoea, in many cases resistant to medical treatment. With the associated vestibulo-cochlear toxicity of many topical antibiotics, their use is dose limited. Removal of the tympanostomy tube has been shown to cure the otorrhoea, however, it is associated with a high persistent perforation rate of 10-28%. A synchronous fat plug myringoplasty was performed with tube removal in an attempt to reduce the residual perforation rate.
  
  
  METHODS
  A retrospective study of 13 consecutive children, nine male and four female, mean age 9.1 years (median=9, range 2-15), with a total of 15 ears (left=6, right=9) had either Shah Tubes (n=5), Shepard Tubes (n=1) or Shah Long Term Tubes (n=9) in-situ for middle ear effusions. The tubes were removed for recurrent otorrhoea. The tubes had been in-situ for a mean of 38.8 months (median=31, range 9-84 months). All ears had recurrent infections, with a variable response to topical antibiotics. All were under the care of one specialist, who performed all the procedures. At the time of tube removal, a standard fat graft myringoplasty was done.
  
  
  RESULTS
  The procedure was successful in 15 of the 15 ears, and all perforations had closed by 3 weeks. Pure tone audiometry improved in 11 ears, remained the same in two and worsened in two (0-10 and 11-15 dBA, respectively). There were no complications arising from the procedure. Mean follow up was 13.7 months (median=9, range 3-31). None of the patients have re-perforated, but two have required re-ventilation of their middle ear for middle effusions, and one of these two has also undergone subsequent adeno-tonsillectomy.
  
  
  CONCLUSIONS
  Our experience in this small series shows that the removal of a tympanostomy tube for recurrent otorrhoea can be successfully managed with a fat plug myringoplasty, with the benefit of a reduction in the persistent perforation rate following tympanostomy tube removal. It is a simple technique that requires little extra operating time with no significant morbidity.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Leicester Royal Infirmary, Leicester LE1 5WW, UK. lennyliew@ukgateway.net
authors.forename: L
authors.initials: L
authors.lastname: Liew
authors.forename: A
authors.initials: A
authors.lastname: Daudia
authors.forename: A A
authors.initials: AA
authors.lastname: Narula
mesh_terms: D000273:Adipose Tissue; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D020878:Device Removal / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008876:Middle Ear Ventilation / Q000295:instrumentation / Q000379:methods*; D009225:Myringoplasty / Q000295:instrumentation / Q000379:methods*; D010034:Otitis Media with Effusion / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D055502:Secondary Prevention; D016896:Treatment Outcome; D018058:Tympanic Membrane Perforation / Q000209:etiology / Q000601:surgery*