title: The role of tympanostomy tubes in surgery for acquired retraction pocket cholesteatoma.
abstract: OBJECTIVE
  1. To determine whether intraoperative tympanostomy tubes (TT) during surgery for acquired retraction pocket cholesteatoma (ARPC) can decrease recurrence of ARPC and retraction pockets (RP). 2. To determine the need for subsequent TT in children that did not initially receive TT.
  
  
  METHODS
  Retrospective review of children who underwent primary surgery for ARPC.
  
  
  METHODS
  Tertiary care children's hospital.
  
  
  METHODS
  Audiometry, operative reports, office findings, and recurrence of ARPC and RP were analyzed. Univariate analysis with Fisher's exact test, Wilcoxon rank-sum and t test, as well as multivariate analysis with logistical regression, were used for statistical analyses.
  
  
  RESULTS
  21 patients had TT at initial surgery and 34 patients did not. The recurrence of ARPC was 24% for the TT Group versus 44% for the no TT group (p=0.09). The incidence of RP was 33% in the TT group versus 41% in the no TT groups (p=0.35). 35% of the no TT group subsequently required TT. Audiometric outcomes were not different between groups. TT placement did not significantly affect the odds of recurrent ARPC and RP (95% CI 0.12-1.83, p=0.28 for ARPC and 95% CI 0.30-4.60, p=0.82 for RP). However, the odds of recurrent ARPC and RP were significantly increased in children with stapes and malleus erosion by cholesteatoma. Children with stapes and malleus involvement had 5.28 and 11.8 times higher odds of recurrent ARPC compared to those without ossicular erosion (95% CI 1.09-25.6, p=0.04 stapes and 95% CI 1.58-88.3, p=0.02 malleus). Similarly, children with malleus involvement had an 18.6 times higher odds of recurrent RP (95% CI 1.62-214, p=0.02) compared to those who did not. Incus erosion was not a significant predictor for recurrent ARPC and RP.
  
  
  CONCLUSIONS
  There was no statistical difference in recurrence or audiometric outcomes between patients who underwent TT versus those who did not during initial surgery for ARPC. However malleus and stapes erosion were significantly associated with recurrent ARPC and RP. These findings suggest that TT at initial ARPC surgery did not play a role in preventing recurrence, but malleus and incus erosion, was predictive of recurrent disease. A larger, prospective study of TT at initial surgery for ARPC is needed.
authors.affiliation: Department of Otolaryngology, University of Pittsburgh School of Medicine, United States.
authors.forename: Nandini
authors.initials: N
authors.lastname: Govil
authors.affiliation: Department of Pediatric Otolaryngology, Children's Hospital of UPMC, United States; Department of Otolaryngology, University of Pittsburgh School of Medicine, United States.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Stapleton
authors.affiliation: Department of Pediatric Otolaryngology, Children's Hospital of UPMC, United States; Department of Otolaryngology, University of Pittsburgh School of Medicine, United States.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Georg
authors.affiliation: Department of Pediatric Otolaryngology, Children's Hospital of UPMC, United States; Department of Otolaryngology, University of Pittsburgh School of Medicine, United States. Electronic address: forrestrfy@gmail.com.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Yellon
mesh_terms: D000293:Adolescent; D001299:Audiometry; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000601:surgery*; D004432:Ear, Middle / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008876:Middle Ear Ventilation / Q000009:adverse effects / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: Acquired cholesteatoma; Pediatric hearing loss; Retraction pocket; Tympanostomy tubes