Myringotomy tubes can be placed before, during, or after cochlear implants are placed, without putting the patient or the success of the cochlear device at undue risk, according to a study of 62 children.
Moreover, the presence of myringotomy tubes might actually protect the implanted ear if it is still susceptible to recurrent acute otitis media, thus sparing the patient from additional procedures, said Dr. Christopher F. Barañano and his associates at the University of Alabama at Birmingham.
The investigators performed what they described as the first independent study to analyze the overall management of pediatric ears that have both myringotomy tubes and cochlear implants (CIs), during the entire course of implant candidacy, placement, and follow-up.
The role of myringotomy tubes in CI is controversial. Fearing that the tubes raise the risk of complications, “some surgeons strive to avoid myringotomy tubes and to establish tympanic membrane integrity before proceeding with CI, while others treat recurrent acute otitis media with myringotomy tubes before [implantation] despite CI candidacy,” they noted.
Dr. Barañano and his colleagues reviewed the records of 189 CI cases treated at their hospital between 1998 and 2008. They found 62 children (78 ears) with ipsilateral myringotomy tubes. The mean patient age was 3.2 years, and mean follow-up was 58 months.
In 32 ears, the tubes were spontaneously extruded, and in another 14 the tubes were removed before CI was undertaken. Tubes were left intact in the remaining 32 ears at the time of CI.
The researchers found that in 11 ears in which a myringotomy tube had been extruded or removed before CI, the placement of new tubes was soon required to manage recurrent otitis. In addition, in three ears in which myringotomy tubes had been removed before CI, severe otitis with mastoiditis developed within several months. New tubes were inserted, and no further sequelae developed, they said (Arch. Otolaryngol. Head Neck Surg. 2010;136:557-60).
In all, 26 patients developed otorrhea, which resolved with standard outpatient medical therapies. Four patients had perforation of the tympanic membrane.
This low rate of complications “made us realize that we could handle these patients like our other patients with recurrent acute otitis media,” Dr. Barañano and his associates wrote.
Disclosures: No financial conflicts of interest were reported.