Experiences with tympanostomy tubes extending over a period of 29 years are compared with the computer-assisted analysis of a questionnaire that was submitted to 500 otolaryngologists. Ventilating tubes are being used by 99.4% of the respondents in the group and are estimated to achieve good to excellent results in 90% of patients treated. Appropriate use of tympanostomy tubes has significantly reduced the incidence of chronic ear disease. A comparison of prophylactic antibiotics and prophylactic ventilating tubes for the prevention of acute otitis media showed that 91% of the participants in the survey found ventilating tubes to be more effective than antibiotics. Benefits from ventilating tubes far outweigh the small number of tube-induced complications.

Acute Disease↗

PubMedDate not supplied

Prolonged middle ear ventilation: the right tube in the right place.

Premature extrusion of ventilating tubes continues to plague both doctor and patient. Migrating epithelium on the lateral surface of the drum has been identified as the principal cause of tube migration and extrusion. This information dictates insertion of a tube in an area where the migrating forces tend to keep the tube in place instead of encouraging rejection. When optimally placed, tubes specifically designed for long-term ventilation will function four times longer than randomly placed conventional tubes. The long-term ventilating tube in use since 1965 has been further refined. A notch and tab on the tube mate with a new inserter/suction device, and this combination permits precise placement through a small incision without tilting and twisting during insertion. Suction may be applied as desired to clear the lumen as the insertion tool is withdrawn.

Adult↗

PubMedDate not supplied

Stapes surgery in patients with osteogenesis imperfecta.

Osteogenesis imperfecta is not in itself a contraindication to stapedectomy. Thirty stapedectomies were performed on 24 patients with osteogenesis imperfecta. Thin ossicles, crural fractures, and thick, mushy, granular footplates predominate in this condition. Deficient, short crura that did not contact the footplate were noted in three patients; this is possibly a new clinical observation. Three times in this small series the endosteum was so thick that it was possible to fenestrate the soft, granular, mush-like footplate without invading the vestibule. Extreme caution in handling the incus is necessary. Conductive hearing loss can be relieved through stapedectomy in patients with osteogenesis imperfecta with about the same level of predictability as in those with otosclerosis.

Adult↗