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Tympanostomy tube (TT) insertion is one of the most common ENT procedures, resulting in millions of TTs being implanted per annum and occurring complications that need to be addressed. Premature TT extrusion (PTTE) is a well-recognised such complication, affecting almost one fifth of these patients, but currently there is no consensus on how to best prevent it. In the current paper, the authors are trying to address this by reviewing the literature for the rates of PTTE from the insertion of TTs in anterior inferior, anterior superior and posterior inferior quadrants of the tympanic membrane. They undertook a systematic review with meta-analysis, following the PRISMA guidelines, analysing a total of 11 papers reporting 2232 TTs. The extrusion rates were evaluated trimonthly over a period of two years and, despite the relatively high risk of bias in some of the included studies, the analysis showed no difference in the outcomes amongst these three quadrants. This is a renovating meta-analysis that challenges the classic teachings of an anterior inferior insertion of TTs, showing no relevant difference in outcomes between the three quadrants of the tympanic membrane. Notably, there are some important limitations in the current study, most prominent being the lack of differentiation between paediatric and adult populations and the high statistical heterogeneity. Despite the limitations, this is the most comprehensive systematic review to this day studying outcomes of TTs and can contribute to the design of more extensive comparative studies that could disclose unknown benefits in selecting alternative insertion sites for TTs.

Meta­analysis of time to extrusion of tympanostomy tubes by tympanic membrane quadrant.
Ungar OJ, Baris H, Oron Y, et al.
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Dimitrios Spinos

NHS West Midlands, UK.

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