The Laryngoscope
Lippincott Williams & Wilkins, Inc., Philadelphia
©
2002 The American Laryngological,
Rhinological and Otological Society, Inc.
A New Ventilation Tube for Long-Term
Middle Ear Ventilation
P. Bonvin; B. Bakke Hansen; E. Hentzer
Objectives: The treatment of secretory otitis me-
dia often requires repeated tubulation of the tym-
panic membrane as the standard ventilation tubes
are extruded before the disease of the middle ear has
remitted. The T-tube and its modification have been
developed to remain longer in situ, often requiring
surgical removal. The rates of subsequent persisting
tympanic membrane perforations and granulations
around the tube have been unacceptably high. In the
search for a long-term ventilation tube with fewer
complications, the Duravent tube (Smith and
Nephew) has been developed. The aim of the study
was to estimate duration in situ and observe compli-
cations in using the Duravent tube compared with
standard tubes and T- tubes. Study Design: Retrospec-
tive study. Methods: In all, 51 patients have been
treated with the Duravent tube over a 2-year period.
In all, 72 Duravent tubes have been inserted. All pa-
tients were subsequently invited for a follow-up ex-
amination at a median time of 28 months (range,
INTRODUCTION
Tympanostomy tubes or grommets have been used
successfully in the treatment of secretory otitis media for
more than 40 years. Most widely, the standard grommet
(
e.g., Armstrong or Shepard) is used. Side effects such as
granulation formation, otorrhoea, tympanosclerosis, and
persisting perforation after extrusion have been ob-
1
served. Too-early extrusion of the tube has been a prob-
lem, which often resulted in the need for several repeat
tubulation procedures. In the early 1970s, a long-term
grommet was developed to solve this problem. However,
its use has been complicated by the need for surgical
removal in up to 90% of the cases. In the search for a
grommet with better “retain ability” than the standard
grommet and lower rate of persisting perforations after
extrusion, the Duravent tube (DT) (Smith and Nephew)
has been developed (Fig. 1). The aim of the present study
was to estimate the duration in situ and observe compli-
cations in using the DT compared with standard tubes and
T-tubes.
2
1
11–43 mo) after the tube insertion and were followed
up for 5 years. Results: The duration in situ was opti-
mal with a median duration of 17 months. The Du-
ravent tube was extruded spontaneously in all but
four cases in which surgical removal was necessary.
The rate of persisting perforations of the tympanic
membrane was low (4.2%) compared with 24% after
the use of the T-tube. Likewise, the usual complica-
tions connected with long-term ventilation tubes
were less frequent (14% compared with 35% when
using the T-tube). Conclusions: In the present study,
the Duravent tube has proved superior to other
known long-term ventilation tubes. The problem of
granulations, otorrhoea, and tube occlusion was sig-
nificantly less than reported in other studies using
the T-tube. Key Words: Long-term middle ear ventila-
tion, ventilation tubes, grommet, tympanic mem-
brane perforation, secretory otitis media.
MATERIALS AND METHODS
In all, 51 patients (26 male and 25 female patients) with
ages ranging from 5 months to 67 years (median age, 6 y) have
been treated with DT over a 2-year period. In 21 patients, bilat-
eral tubulation has been performed. A total of 72 Duravent tubes
have been inserted. All patients were subsequently invited for a
follow-up examination at a median time of 28 months (range,
11–43 mo) after the tube insertion and were followed up for 5
years. The evaluation included information on age, sex, date of
insertion, number of previous myringotomies and ventilation
tube insertions, otorrhea, duration in situ of the tube, and otomi-
croscopic examination. Whether the tube was in situ and func-
tional or had been extruded spontaneously was noted, and the
drum was examined for tympanosclerosis, granulation, and per-
sisting perforation. A perforation is said to be chronic when it
persists for at least 6 months after tube removal, although some
3
perorations heal spontaneously even after a year.
Laryngoscope, 112:2054–2056, 2002
RESULTS
In all, 94% of the inserted tubes (68 of 72 tubes) could
be followed up. Seventy-eight percent (56 of 72) of the
treated ears had a history of earlier grommet insertion
varying from one to six times. In 10 ears, the insertion of
DT tube was performed in connection with a tympanoplas-
tic operation.
From the Department of Otolaryngology, Fyn Hospital, Svendborg,
Denmark.
Editor’s Note: This Manuscript was accepted for publication July 2,
2002.
Send Correspondence to Pascal Bonvin, MD, Department of Otolar-
yngology, Fyn Hospital, 5700 Svendborg, Denmark. E-mail:
Laryngoscope 112: November 2002
Bonvin et al.: Long-Term Middle Ear Ventilation
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