Published online May 6, 2020. doi: 10.12998/wjcc.v8.i9.1592
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
Myringotomy with ventilation tube placement (M&T) plays an important role in the treatment of refractory otitis media by maintaining continuous ventilation and pressure balance and promoting secretion drainage in the middle ear. 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 M&T procedures, which have the concomitant 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 M&T. Previous reports described strategies designed to inhibit the development of bacterial biofilms on tympanostomy tubes, such as antibiotic-coated, ion-bombarded silicone, and fluoroplastic tympanostomy tubes, which had been proved to be incapable of completely inhibiting bacterial attachment. However, studies about biofilms are still lacking, and it is uncertain whether directly removing the biofilm can be a well-tolerated and effective treatment for long-term tube retention of tympanostomy ventilation tubes.
In this study, directly removing the biofilm was performed to maintain tube position and patency as well as control complications. Our study aimed to explore the value of directly removing the biofilm for long-term ventilation tube retention.
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 M&T. Patients in the treatment group underwent regular biofilm exfoliation surgery in the clinic, whereas the control group did not undergo biofilm removal. Only conventional ventilation tubes were placed in this study. Outcome measures were tube position and patency. Tube retention time and any complications were documented.
In this study, we identified a safe and effective method for long-term retention of conventional ventilation tube in patients requiring an indwelling tube. Tympanostomy tube retention time was longer in the treatment group than in the control group. More tympanostomy tubes were found to be in position and patent in the treatment group in the follow-up intervals than in the control group. Furthermore, during the course of tube retention, there was no complication in either group.
Biofilm removal has been proven to be a safe and effective treatment for long-term tube retention, even with the use of short-term tube. It is expected to provide a new treatment method for many diseases that necessitate long-term ventilation tube retention.
Considering the small sample size, further study is needed to determine whether biofilm removal is a suitable alternative to repeated tympanostomy tube placement in selected patients.