A Comparison of Retention and Complication Rates of Large‐Bore (Paparella II) and Small‐Bore Middle Ear Ventilating Tubes

Abstract

Large-bore myringotomy tubes are usually reserved for the treatment of refractory middle ear effusion. Theoretically, they have an extended intubation time and a higher complication rate. There is, however, scant support of this in the literature. The duration of intubation, efficacy, and complication rates of the large-bore Paparella type II tube were compared with Paparella type I, Shepard, and Armstrong tubes. The study included 242 patients with 600 intubations. In addition, a subpopulation of patients receiving their initial intubation during this study was reviewed. Findings were similar for both groups. Paparella type II tubes had a prolonged period of intubation and a decreased reintubation rate when compared with the smaller bore tubes. Larger bore tubes had an increased complication rate when compared with the smaller bore tubes. Complications included occasional or frequent otorrhea and an increased rate of permanent perforation of the tympanic membrane. There was no instance of cholesteatoma formation secondary to intubation. Guidelines are presented for the use of the Paparella type II tube.

Complications of Tympanostomy Tubes Inserted for Facilitation of Hyperbaric Oxygen Therapy

“…11,12,15 A greater incidence is also seen with largebore tubes and Goode T tubes, both of which have a longer average duration of intubation than grommets, and with increasing atelectasis of the tympanic membrane. [16][17][18] Inmostofthereportscited,otorrheacouldbecontrolled with topical antibiotics and occasional tube removal. Perforations have often been noted to spontaneously close with a longer period of observation.…”

Timing for Removal of Asymptomatic Long-Term Ventilation Tube in Children

“…The tube insertion relieves the symptoms of the effusion such as the conducting hearing loss and episodes of acute otitis media. The procedure is not without risk; the formation of granulation tissue, tube extrusion into the middle ear space, cholesteatoma formation, external otitis media and suppurative otitis media are some of the recognized complications [5,6]. The closure of a perforation of the TM after tube extrusion occurs by migration of the squamous epithelial layer with the fibrous and mucosal layer following behind [7].…”

“…If a tube is removed too soon, OME is likely to recur, but if it is retained too long, the chances of complications become higher [5,6]. When a tube does not displace spontaneously, the otorhinolaryngologist faces the difficult decision for when to remove the tube with no definite consensus regarding the optimal length of the intubation period.…”

Hearing aids versus ventilation tubes in persistent otitis media with effusion: a survey of clinical practice

“…7 It appears that in OME ventilation tubes do not protect the ears against the long-term development of attic retraction or cholesteatoma, and there is no long-term audiological bene t. [3][4][5]7 On the contrary the insertion of ventilation tubes can itself cause complications such as tympanosclerosis, otorrhoea and persistent perforation, the extent of which depend on the particular design and duration of the ventilation tube. [8][9][10][11] In our survey ve per cent of otolaryngologists in group B gave repeated infection caused by ventilation tubes to be a reason for prescribing hearing aids. If ventilation tubes cannot prevent middle-ear complications, but can cause additional problems, why should ventilation tubes be re-inserted if OME recurs after the initial insertion of the ventilation tube along with surgical attention to possible predisposing factors such as adenoidectomy?…”