Multiple VTIs Found to Increased Risk of Cholesteatoma


Children with persistent or refractory middle ear infections who required multiple VTIs are at increased risk of cholesteatoma formation. Each year more than half a million VTI surgeries are performed on children. The tube helps to maintain drainage of fluid and pus, reducing the risk of future ear infection and decrease hearing loss which can be caused by middle ear fluid and infections.

Myringotomy with VTI is an extremely common and safe procedure with minimal complications. The complications include perforation (failure of the ear drum to heal when the tube is removed), scarring of the ear drum, and cholesteatoma formation. Cholesteatoma is an abnormal skin growth in the middle ear behind the eardrum.

This last complication is the focus of a population-based retrospective cohort study published online in the January issue of the journal The Laryngoscope, looking at the risk factors for the formation of cholesteatoma following VTI.

The researchers used health data from all private and public hospitals in Western Australia for children who had at least one VTI from 1980 to 2004 to identify subsequent hospital admissions for cholesteatoma.

The researchers identified 45,980 children who underwent at least one VTI with 460 subsequently developing cholesteatoma. The risk of cholesteatoma formation was found to increase with multiple VTIs. Children who developed cholesteatoma within 15 years after one VTI was 0.9%, after two VTIs 2.1%, after three VTIs 3.8%, and after four or more VTIs 5.2%.


Timing of the VTI was found to be important. The rate of developing cholesteatoma increased 10% for each additional year in age before first VTI. For children who underwent two or more VTIs, the rate of cholesteatoma increased 21% with each additional year between VTIs.

Adenoid removal was found to be associated with a 27% reduction in the rate of developing cholesteatoma.

Children who have frequent and repeated ear infections are less likely to have long term cholesteatoma complications if the first VTI is done at an early age, if subsequent VTIs without delay when needed, and enlarged adenoids are removed.

Cholesteatomas often develop as cysts or pouches that shed layers of old skin, which build up inside the middle ear. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear. Hearing loss, dizziness, and facial muscle paralysis are rare, but can result from continued cholesteatoma growth.

Factors associated with developing cholesteatoma: A study of 45,980 children with middle ear disease; The Laryngoscope, Published Online: Jan 7, 2010, DOI: 10.1002/lary.20765; Katrina Spilsbury, PhD, Ian Miller, MRCSI, James B. Semmens, PhD, Francis J. Lannigan, MD, FRACS