When should retained Paparella type I tympanostomy tubes be removed in asymptomatic children?

OBJECTIVES: Tympanostomy tubes are routinely used for the treatment of otitis media with effusion (OME). There is no definite consensus on the optimal length of the intubation period and the timing of tube removal. This study was designed to determine the appropriate time for tympanostomy tube removal in asymptomatic patients of preschool age. METHODS: A retrospective study was conducted in 336 patients (478 ears) under the age of 7 years old who underwent tympanostomy tube insertion or removal from January 2006 to September 2010 at our institution. The information gathered from chart review included patients' age at the time of tube insertion, duration of intubation, and the presence of complications, such as tube site infection and persistent tympanic membrane perforation. Logistic regression, chi-square test and Fisher's exact test were used to determine the statistical significance of observations. RESULTS: The spontaneous extrusion rate of tympanostomy tubes was about 90% at 18 months and showed a plateau after 18 months. The OME recurrence rate decreased after 12 months of intubation, and complications such as tube site infection and persistent tympanic membrane perforation increased after 15 months of intubation. CONCLUSION: Tympanostomy tubes removed before 12 months showed a high possibility of recurrence. Removal after 15 months showed an increased possibility of complications. Spontaneous extrusion seldom occurred after 18 months. From these findings, we concluded that asymptomatically retained tympanostomy tubes are recommended to remove when a tube is retained for more than 18 months.

Surgical management of labyrinthine fistula in chronic otitis media with cholesteatoma.

OBJECTIVE: To present the surgical outcomes of complete removal of the matrix of labyrinthine fistulas in a large series of middle ear cholesteatomas. PATIENTS AND METHODS: This is a retrospective study. We analyzed 38 of 778 patients who were operated on for cholesteatoma and were proved to have labyrinthine fistula from 1991 to 2007. For this study, a more aggressive strategy was adopted that compromised immediate total removal of the matrix, regardless of size. To evaluate the safety and efficacy of the procedure, pre and postoperative pure-tone audiometry were compared and the recurrence rate was analyzed. Relevant data from the literature using a wide array of strategies were compared with our results. RESULTS: Only two patients suffered from postoperative hearing deterioration of bone conduction of more than 10dB HL. There was no relationship between the size of labyrinthine fistulas and postoperative hearing deterioration. Recurrence of labyrinthine fistulas was not found. CONCLUSIONS: Total removal of the cholesteatoma matrix in one step is a safe and effective method for the treatment of labyrinthine fistulas.

Headache induced by isolated sphenoid fungal sinusitis: sinus headache?

In this article, we report a case of isolated sphenoid fungal sinusitis which only presented as headache. We review the literature of this rare but interesting lesion according to the revised 2004 IHS diagnostic criteria for "Headache attributed to Rhinosinusitis".