Dr Berry has raised an interesting point regarding the sequence of steps for an error-free ventilation tube insertion. He suggests an addition to our 10 steps1 to ensure that the sides of the incision are everted so that nothing is tucked into the middle ear, where it could form a cholesteatoma. However, he cites no evidence in support of such a risk being present. Could it be that no such evidence exists?
Hussain SSM. The Difficulty of Identifying and Enumerating Human Errors—Reply. Arch Otolaryngol Head Neck Surg. 2005;131(6):539. doi:10.1001/archotol.131.6.539-b
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