Long-term middle ear ventilation.

A 15 year experience using wide flange tube for long term ventilation is reported with emphasis on complications and is compared in some respects to a small series of Paparella tube implants. At one time or another 70% of the wide flange tube implants were complicated, as were 100% of the Paparella tubes. The incidence of infection over a long period is high, at times only manageable with removal of the tube. However, longevity when tubes are removed for uncontrolled complication is still almost 3 years and as long as 12 years. The average longevity for electively removed tubes exceeds 4 years. Peritubal drum atrophy is a significant side effect of long-term ventilation and predisposes to permanent perforation. It contributes to spontaneous extrusion which occurred in 5% of the implants. There were 49 permanent perforations in the wide flange series. Yet, a permanent perforation for permanent or severe chronic Eustachian tube dysfunction is not all bad. These permanent, mostly anterior perforations were not associated with much hearing loss; an average of 7.1 bd. Alternative methods to achieve permanent ventilation are discussed and do not seem more reliable or less complication prone.