Effect of Epithelial Freshening and Gelfoam Plugging on Myringeal Healing Following Elective Removal of Tympanostomy Tubes: A Comparative Randomized Study

Background: Tympanostomy along with ventilation tube (VT) is inevitable for the prevention of long term sequelae of otitis media with effusion (OME) and securing hearing improvement. However, the procedure has its own risks. The most significant one is persistent perforation. Its incidence increases when the tube is removed surgically. This study was carried out to evaluate and assess the possible therapeutic effect of epithelial freshening combined with gelfoam plugging on improving postoperative healing following elective removal of tympanostomy tubes. Patients and Methods: The study enrolled 52 consecutive children (60 ears) who had their ventilation tubes (VTs) removed surgically. Tubes which remained in-situ for mean of 37.5 months (range 32-50 months) were removed due to recurrent or persistent otorrhea; tube no longer needed or resistant granulation tissue and polyps. Patients were divided into 2 groups: Group (I) patients had their tubes removed surgically without further surgical procedures (control group); and Group (II) patients had their tubes removed followed by epithelial freshening of perforation edges and gelfoam plugging to improve postoperative healing. Results: Myringeal healing occurred over a shorter time in group II members as all perforations were closed by a mean of 2.9 weeks; compared to group I patients in which healing occurred over a mean time of 5.6 weeks (p 0.04). In group II, postoperative pure tone audiometry improved in 27 patients (90%) and remained the same in another three (10%); compared to only 18 (60%) and 12 patient (40%) in group I respectively (p 0.03). Over a mean follow-up period of 6.5 months (range 3-16), no morbidity or complication occurred from the procedure in group II patients. In group I patients, morbidity occurred in 7 cases (23.3%) in the form of persistent perforation (4 cases) and recurrent OME (3 cases). Conclusions: Epithelial freshening combined with gelfoam plugging had a successful therapeutic effect on improving postoperative healing following elective surgical removal of tympanostomy tubes. The procedure was simple, required few extra minutes and was associated with favorable outcome and no morbidity.