Cholesteatomas associated with ventilation tube insertion

Objectives: To determine the incidence of cholesteatoma formation associated with ventilation tube (VT) placement and to identify and analyze the variables and risk factors that may predict or predispose to this complication. Design: We reviewed the medical records of 2829 children following VT insertion between the years 1978 and 1997 to obtain 1- to 20- year follow-up data. Setting: Departments of Otolaryngology-Head and Neck Surgery and outpatient clinics of 2 tertiary referral academic medical centers. Patients: A study population of 2829 children, ranging in age from 1.2 to 14 years (5575 ears), underwent a total of 6701 VT placements. Main Outcome Measure: Cholesteatomas were considered a complication of VT placement whenever they developed at or near the site of the tube insertion. Results: Cholesteatomas directly attributed to VT placement occurred in 1.1% of the ears that were operated on. A higher incidence occurred (1) in children younger than 5 years, (2) when Goode T-tubes were used, (3) in cases with repeated insertions of tubes, (4) with intubation exceeding 12 months, and (5) in cases with frequent postoperative otorrhea. Conclusions: Cholesteatoma formation associated with VT placement occurs in 1.1% of the ears that are operated on, and therefore it should be discussed with patients or parents prior to surgery. Periodic and long-term follow-up microscopic examinations of the eardrum should be performed in all patients following tubal extrusion or removal, especially in those at high risk for developing a secondary cholesteatoma, to detect this complication as early as possible.