Randomized clinical trial of post-operative outcomes following posterior versus anterior tympanostomy tube placement: preliminary results at 2-12 week follow-up.

INTRODUCTION

Tympanostomy tubes (TTs) are a common otolaryngologic procedure. Historically, tubes placed in the anterior inferior (AI) quadrant were thought to last longer, reduce ossicular damage, and minimize hearing loss. However, perforation risk remains at 2-16 %. AI perforations may require more complicated repair compared to PI perforations. This study aims at comparing early hearing outcomes between AI and PI TT placement after 3 months.

METHODS

Randomized controlled trial was conducted at a tertiary pediatric hospital. Children (6 months-14 years) undergoing initial TT placement were randomized to receive a tube in AI in one ear and a tube in the PI quadrant in the opposite ear. Exclusion criteria included non-RAOM indications, tube type other than Armstrong, anatomical abnormalities, or genetic conditions. Audiometry and caregiver questionnaires at 3-month follow-up were analyzed using McNemar's Chi-squared test.

RESULTS

Of 386 enrolled, 118 completed audiometry (73 with ear-specific data). Only one patient had mild hearing loss (30 dB PTA at 500 Hz) in the PI ear. Tympanometry in 41 participants showed similar rates of flattened admittance: 9.8 % in PI vs. 7.3 % in AI (OR: 1.00). Caregivers of 303 participants reported tube blockage in 5.6 % (PI) vs. 5.9 % (AI) and otorrhea in 25.7 % (PI) vs. 24.4 % (AI). Provider forms for 86 patients showed similar occlusion rates. Tube patency could not be assessed in 41.9 % of PI vs. 3.5 % of AI tubes due to visualization limitations.

CONCLUSION

No significant differences in hearing, tube extrusion, or function were observed between AI and PI TT placement at first follow-up.