Myringotomy versus ventilation tubes in secretory otitis media: eardrum pathology, hearing, and eustachian tube function 25 years after treatment

OBJECTIVE: This report documents the dynamics of eardrum pathology, hearing acuity, and eustachian tube function during 25 years after treatment of bilateral secretory otitis media. The included children were treated by myringotomy on the left ear and ventilation tube insertion on the right ear.

MATERIALS AND METHODS: Two hundred twenty-four children with bilateral secretory otitis media were treated by bilateral myringotomy and insertion of a ventilation tube on the right side only. The children were reexamined by otomicroscopy, tympanometry, and pure tone audiometry after 3, 7, and 25 years. At the last evaluation, the eustachian tube function was evaluated by the 9-step test.

RESULTS: 1) Myringosclerosis and late atrophy were more prevalent in tube ears. 2) Prevalence of eardrum retraction decreased over time, whereas that of sclerosis remained unchanged in tube ears and increased in myringotomy ears. 3) Prevalence of atrophy increased over time in tube ears. 4) Extension of myringosclerosis increased, whereas that of atrophy and tensa retraction decreased over time, regardless of treatment. 5) Hearing was better in the tube ear during, but not after treatment. 6) Tympanometric findings were not related to treatment. 7) Eustachian tube function at 25 years was not related to treatment.

CONCLUSION: The insertion of a ventilation tube after myringotomy leads not only to better hearing until extrusion but also to an increased prevalence of long-term pathologic changes of the eardrum, that is, myringosclerosis and late atrophy. The temporary hearing improvement may reduce the risk of detrimental effects on speech and language development. The prevalence and extension of the various subtypes of pathology change over the years after treatment, which implies the existence of intrinsic repair mechanisms, but also continuing progression of disease and/or treatment sequelae many years after treatment. However, these changes do not seem to affect the hearing acuity in the long term. The treatment modality has no impact on late eustachian tube function.