Tympanostomy Tube Placement: The Effect of Location on Tube Retention and Risk of Perforation

ABSTRACT Objective The retrospective cohort study compares tube location in the anterior‐inferior quadrant versus the posterior‐inferior quadrant and time of tube retention along with the risk of early extrusion and perforation. The study hypothesis holds that both anterior‐inferior placement and posterior‐inferior placement are equally effective and safe locations for tube placement with equal tube retention and risk for tympanic membrane perforation. Methods An IRB‐approved retrospective chart review was completed at a major Academic Center's Children's Hospital. The study included data from children who underwent tube placement between 6 months and 16 years old between February 2019–February 2021. Demographics and clinical factors were collected. Results Of the 905 patients and 1800 ears, a total of 1584 ears had tubes placed in the anterior‐inferior quadrant and 216 were placed in the posterior‐inferior quadrant. Tubes remained in place for 487 days in the anterior‐inferior quadrant and 456 in the posterior‐inferior quadrant. The risk of perforation was 1.4% in the anterior‐inferior quadrant and 0% in our study for the posterior‐inferior quadrant. Univariate analysis showed a difference but was not significantly different (1.10 [0.95, 1.27]). This slight difference was confirmed by multivariate analysis HR = 1.11 [0.96, 1.30]. Conclusion This study shows that there is no difference in tube retention or risk of tympanic membrane perforation based on location of tympanostomy tube placement either in the anterior‐inferior quadrant versus the posterior‐inferior quadrant. Factors associated with earlier tube extrusion included older age, cleft palate, and recurrent acute otitis media as the diagnosis. T‐tubes had slower extrusion, as expected. Level of Evidence 3