Case Control Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2020; 8(9): 1592-1599
Published online May 6, 2020. doi: 10.12998/wjcc.v8.i9.1592
Removal of biofilm is essential for long-term ventilation tube retention
Qiang Ma, Hui Wang, Zheng-Nong Chen, Ya-Qin Wu, Dong-Zhen Yu, Peng-Jun Wang, Hai-Bo Shi, Kai-Ming Su
Qiang Ma, Hui Wang, Zheng-Nong Chen, Ya-Qin Wu, Dong-Zhen Yu, Peng-Jun Wang, Hai-Bo Shi, Kai-Ming Su, Department of Otorhinolaryngology–Head & Neck Surgery, the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
Hai-Bo Shi, Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai 200233, China
Author contributions: Ma Q wrote the manuscript draft; Wang PJ and Shi HB collected the clinical data; Shi HB designed the study; Wang PJ revised the manuscript; Chen ZN, Wu YQ, and Wang H performed the treatments; Su KM and Yu DZ evaluated the efficacy of the method; all authors read and approved the final manuscript.
Supported by Shanghai Leadership Talent Training Plan, No. 2017062; the Key Project of Shanghai Jiao Tong University Medicine Science and Engineering Interdisciplinary Foundation, No. YG2016ZD02; Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support, No. 20152233; Multi-Center Clinical Research Plan of Medical College of Shanghai Jiao Tong University, No. DLY201823; the Clinical Research Plan of Shanghai Shen Kang Hospital Development Center, No. 16CR4022A and No. 16CR3041A; and National Natural Science Foundation of China, No. 81974142.
Institutional review board statement: The study was approved by the Ethics Committee of Shanghai Sixth People’s Hospital (YS-2018-101).
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Peng-Jun Wang, MD, Doctor, Department of Otorhinolaryngology-Head & Neck Surgery, the Sixth People's Hospital Affiliated to Shanghai Jiaotong University, 600 Yishan Road, Shanghai 200233, China. wangpj@sjtu.edu.cn
Received: December 16, 2019
Peer-review started: December 16, 2019
First decision: February 20, 2020
Revised: March 4, 2020
Accepted: April 15, 2020
Article in press: April 15, 2020
Published online: May 6, 2020
Processing time: 135 Days and 22.3 Hours
Abstract
BACKGROUND

Although long-term retention of a ventilation tube is required in many ear diseases, spontaneous removal of conventional ventilation tube is observed in patients within 3 to 12 mo. To address this issue, we aimed to determine a new method for long-term retention of the ventilation tube.

AIM

To explore the value of removing the biofilm for long-term retention of tympanostomy ventilation tubes.

METHODS

A case-control study design was used to evaluate the safety and effectiveness of long-term tube retention by directly removing the biofilm (via surgical exfoliation) in patients who underwent myringotomy with ventilation tube placement. The patients were randomly divided into two groups: Control group and treatment group. Patients in the treatment group underwent regular biofilm exfoliation surgery in the clinic, whereas those in the control group did not have their biofilm removed. Only conventional ventilation tubes were placed in this study. Outcome measures were tube position and patency. Tube retention time and any complications were documented.

RESULTS

Eight patients with biofilm removal and eight patients without biofilm removal as a control group were enrolled in the study. The tympanostomy tube retention time was significantly longer in the treatment group (43.5 ± 26.4 mo) than in the control group (9.5 ± 6.9 mo) (P = 0.003). More tympanostomy tubes were found to be patent and in correct position in the treatment group during the follow-up intervals than in the control group (P = 0.01).

CONCLUSION

Despite the use of short-term ventilation tubes, direct biofilm removal can be a well-tolerated and effective treatment for long-term tube retention of tympanostomy ventilation tubes in patients who underwent myringotomy.

Keywords: Tympanostomy tubes; Biofilm; Complication management; Long-term retention; Ménière disease; Refractory otitis media with effusion

Core tip: Long-term ventilation tube retention is necessary in many diseases, such as refractory otitis media with effusion and eustachian tube dysfunction, as well as with the use of Meniett therapy for Ménière disease. However, conventional ventilation tubes are expelled spontaneously within 3 to 12 mo because of tube extrusion or obstruction. Therefore, patients have to undergo two or more myringotomy with ventilation tube placement procedures, along with the risks of anesthesia and surgery, excessive injury to the tympanic membrane and external auditory canal, medical care costs, and impact on school or work. The biofilm plays a crucial role in the development of extrusion or obstruction after myringotomy with ventilation tube placement. It was revealed that, despite the use of short-term tube, biofilm removal has been proven to be a safe and effective treatment for long-term tube retention.