Effect of Tympanostomy Tube Removal Technique on Surgical Success Rate and Operative Time

Saturday, September 28, 2024

10:12 AM – 10:18 AM EDT

Location: MBCC, 225

Disclosure(s):

Nicole L. Aaronson, MD, MBA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Allison M. Blackwell, PA-C:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Emily E. Vanella:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Heather C. Nardone, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Tympanostomy tube removal is a common procedure following tube placement. The most common complication of this is persistent perforation. Different techniques for tube removal include: tube removal alone, tricholoracetic acid (TCA) myringoplasty, and cold myringoplasty with surgical instruments. This study seeks to determine if techniques used affect success rate or surgical time.

Methods: This study was performed as an IRB-approved retrospective chart review at a tertiary care children’s hospital. Procedure codes for tube removal were used to extract charts from the electronic medical record from 2008 to 2023. Data was collected on tube removal technique, surgical success, operative time, number of prior sets of PE tubes, craniofacial conditions, and indications for tube removal. In total, 1,620 patient charts were included in final analysis. Primary outcome measure was surgical success, which was defined as no residual perforation. Logistic regression was used to model the relationship between the myringoplasty method and the rate of hole closure, adjusting for potential confounders. Kruskal-Wallis test and Dunn's test for pairwise comparisons were used to analyze difference in operative time based on myringoplasty method.

Results: Success rate was 92.5% for TCA myringoplasty, 77.2% for cold myringoplasty, and 73.8% for tube removal alone. The difference in success rate between TCA myringoplasty and cold myringoplasty was statistically significant (p= 0.0021). The difference in success rate between cold myringoplasty and tube removal alone is approaching statistical significance (p = 0.0735). This suggests that there might be a lower likelihood of closure at follow-up with tube removal alone, but this is not conclusive this without statistical significance. Median operative time was 4 minutes for tube removal alone and cold myringoplasty and 5 minutes for TCA myringoplasty (p < 0.0001).

Conclusions: TCA myringoplasty shows a greater surgical success rate that cold myringoplasty or tube removal alone but does have a longer operative time.

Presenting Author(s)

Nicole L. Aaronson, MD, MBA

Pediatric Otolaryngologist; Clinical Associate Professor of Otolaryngology and Pediatrics
Nemours Children's Health of Delaware; Sidney Kimmel Medical College at Thomas Jefferson University
Wilmington, DE, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

AB

Allison M. Blackwell, PA-C

Physician Assistant
Nemours Children's Hospital of Delaware
Wilmington, DE, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
OK

Onyinyechi Kenine

undergraduate student
University of Delaware, United States

Disclosure information not submitted.
EV

Emily E. Vanella

undergraduate student
University of Delaware
Oxford, Pennsylvania, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

HN

Heather C. Nardone, MD

Clinical Associate Professor of Otolaryngology and Pediatrics
Sidney Kimmel Medical College at Thomas Jefferson University
Wilmington, DE, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.