title: A systematic review of concomitant interventions to prevent persistent perforations following the removal of long-term ventilation tubes.
abstract: OBJECTIVE
  To review the current evidence for the use of concomitant interventions to reduce the persistent perforation rate following the removal of long-term ventilation tubes.
  
  
  METHODS
  A systematic review of the literature and meta-analysis of randomised controlled trials on this topic.
  
  
  METHODS
  Medline (1952-2008), EMBASE (1974-2008) and the Cochrane Central Register of Controlled Trials. A combination of search terms were used in a search strategy derived from guidance from the Cochrane collaboration.
  
  
  METHODS
  A review of all trials by two authors with grading of the level of evidence.
  
  
  RESULTS
  Fifteen studies using a variety of interventions were identified.
  
  
  CONCLUSIONS
  A multi-centre randomised controlled trial is indicated to validate findings of previous studies and elucidate any optimum intervention to reduce the persistent perforation rate.
authors.affiliation: Department of Otolaryngology, North Cheshire Hospitals NHS Trust, Lovely Lane, Warrington, WA5 1QG, UK. jameskeir@hotmail.com
authors.forename: J
authors.initials: J
authors.lastname: Keir
authors.forename: R
authors.initials: R
authors.lastname: Clarke
mesh_terms: 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; D010034:Otitis Media with Effusion / Q000175:diagnosis / Q000601:surgery*; D011322:Primary Prevention / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D055502:Secondary Prevention; D013997:Time Factors; D018058:Tympanic Membrane Perforation / Q000517:prevention & control*; D006113:United Kingdom