Is ventilation tube placement beneficial during tympanoplasty for atelectatic tympanic membranes?

BACKGROUND The atelectatic tympanic membrane poses a significant (and age old) management challenge. Although often without sequelae, the under-ventilated middle ear and retracted drum can progress to ossicular erosion, hearing loss, or cholesteatoma formation. Management of this problem remains difficult given that the etiology of the atelectatic membrane is not completely understood. It is unknown if Eustatiachian tube dysfunction and negative pressure in the middle ear are solely responsible for this problem. Tympanoplasty has been used to address this problem, with a number of publications examining the use of cartilage to support the weakened, atelectatic drum. Given the possible role for under ventilation and Eustachian tube dysfunction, it makes intuitive sense that placement of a ventilation tube at the time of tympanoplasty would improve outcomes and prevent recurrence. Earlier descriptions of tympanoplasty utilized tube placement for this purpose. However, these studies did not compare tympanoplasty with and without tubes. This review will examine the evidence for placing tubes at the time of tympanoplasty.