title: Outcomes in children with perforated tympanic membranes after tympanostomy tube placement: results using a pilot treatment algorithm.
abstract: OBJECTIVE
  The objective of this study was to examine the success of a pilot treatment algorithm for tympanic membrane perforations in children after tympanostomy tube placement.
  
  
  METHODS
  A retrospective chart review of children with diagnosed tympanic membrane perforations after tympanostomy tube placement from 1998 to 2003 at a tertiary care children's hospital was performed. The patients had been treated according to an algorithm used by 2 pediatric otolaryngologists for management of tympanic membrane perforations: observation vs myringoplasty. Success rates were examined.
  
  
  RESULTS
  Ninety-five children were identified, 27% of whom had nonhealing perforations after tube extrusion; 73% of the perforations were caused by a retained tube. The median duration of tube retention was 48 months, ranging from 13 to 120 months. After the treatment protocol, 76% of the patients underwent gelatin film or paper patch myringoplasty, 23% had adipose myringoplasty, and 1% were observed. Overall, 91% had healed perforations after the first intervention. Among those requiring a second intervention, the sizes of initial perforations were between 15% and 40%, with postrepair perforation sizes between 5% and 40%. In addition, 75% of those requiring a second intervention underwent tympanoplasty repair and 25% had fat patch myringoplasty. None required a third intervention.
  
  
  CONCLUSIONS
  Our treatment algorithm for children with tympanic membrane perforations after tympanostomy tube placement appears to be successful and is an excellent model for other clinicians.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA 23507-1914, USA.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Schraff
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Markham
authors.forename: Camille
authors.initials: C
authors.lastname: Welch
authors.forename: David H
authors.initials: DH
authors.lastname: Darrow
authors.forename: Craig S
authors.initials: CS
authors.lastname: Derkay
mesh_terms: D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008876:Middle Ear Ventilation / Q000009:adverse effects*; D009225:Myringoplasty; D010865:Pilot Projects; D012189:Retrospective Studies; D018058:Tympanic Membrane Perforation / Q000209:etiology* / Q000628:therapy*