Meta-analysis of time to extrusion of tympanostomy tubes by tympanic membrane quadrant

Objectives: To investigate the published time to extrusion of tympanostomy tubes inserted in the various quadrants of the tympanic membrane. Methods: Publications were selected by a search with ‘PubMed’, ‘Embase’ and ‘Web of Science’. A meta-analysis of time to extrusion as a function of tympanic membrane quadrant intubation was performed. Design, Setting, Participant-Not relevant Main Outcome Measured: Extrusion rate of tympanostomy tubes inserted in the various quadrants of the tympanic membrane. Results: Eleven studies describing 2232 tympanostomy tubes were enrolled into the quantitative meta-analysis. The extrusion rate was evaluated at 3-month intervals up to 24 months post-intubation, and it did not differ significantly at any of the time points tested for the superior and inferior anterior quadrants. The cumulative extrusion rates were as follows: 11 and 9%, 32 and 23%, 59 and 36%, 80 and 67%, 87 and 70%, 88 and 82%, and 96 and 89% in the superior and anterior quadrants, respectively, at 3, 6, 9, 15, 18, 21 and 24 months post-intubation, respectively. Conclusion: Time to extrusion of tympanostomy tubes are similar for all 3 tympanic membrane quadrants. The anterior superior quadrant intubation has no superiority in terms of intubation time.