Ventilation tube surgery and middle ear irrigation

Abstract

Tympanostomy and insertion of ventilation tubes has become one of the most commonly performed operations in the United States. Most authors reporting complications of this procedure describe a postoperative rate of otorrhea in the range of 10%-20% with some reports much higher. This rate of presumed suppuration would generally be considered high by surgeons operating in other areas of the body. It is a commonly accepted surgical practice to follow incision and drainage of a relatively closed space effusion with irrigation of that space. This is true in the surgery for the paranasal sinuses, deep space infections of the neck, joint spaces, and abscesses in general. However, this practice is not routinely performed when incising and draining the middle ear. We have completed a prospective controlled double blind study on post-tympanostomy tube otorrhea utilizing irrigation of the middle ear. In 220 consecutive cases, the use of middle ear irrigation reduced postoperative infections in the first 6 months from 16% to 4%. Irrigation was also found to be useful in removing very thick effusions from the middle ear by displacement, including those effusions localized in the hypo or epitympanum which were not initially identified at the time of incision and suction. A soft plastic, angled irrigation catheter with radial ports was developed for this purpose.