Postop Tympanostomy Tube Obstruction Common

Laurie Barclay, MD

July 11, 2014

More than 10% of children undergoing tympanostomy had postoperative tube obstruction, with serous fluid and increased time to follow-up visit predicting tube occlusion, according to a retrospective record review published online July 10 in JAMA Otolaryngology Head & Neck Surgery.

"Myringotomy and tympanostomy tube placement for chronic otitis media with effusion is the most common reason for a child to undergo anesthesia in the United States," write David E. Conrad, MD, from the Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware, and the Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, and colleagues. "Postoperative tube obstruction occurs in 1.4% to 36.0% of cases and remains a challenge in achieving middle ear ventilation."

The study goal was to identify risk factors predicting postoperative tympanostomy tube obstruction based on chart review of 248 patients undergoing tympanostomy tube placement and postoperative otic drop therapy in a tertiary care pediatric hospital between March 2007 and June 2011. Mean age was 2.54 years.

Occlusion of 1 or both tubes was apparent at first follow-up in 10.6% of patients. Tube patency was 3 times more likely in patients with no middle ear fluid than in those with serous fluid (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.2 - 10.6; P = .02). Patency was significantly inversely correlated with time between surgery and follow-up, with an OR per day of follow-up delay of 0.990 (95% CI, 0.981 - 0.999; P = .01).

In contrast, tube patency was not significantly associated with body mass index percentile, sex, or procedure type (tympanostomy tube placement alone or with adenoidectomy and/or tonsillectomy).

"Post-[tympanostomy tube] obstruction remains a frequent and challenging aspect of surgical treatment of otitis media in children," the authors write. "We found that children with serous effusions and those with longer follow-up durations have occluded tubes more often. Further study is warranted to determine if changes in postoperative drop duration and composition improve patency rates."

Limitations of this study include its retrospective, observational design; reliance on record review; and failure to control for otic drop content and duration.

"An unexpected, yet important, result of our analysis suggests that a longer course of topical otic drops should be administered when any type of fluid is encountered in the ear at the time of surgery," the study authors conclude. "One must consider the added cost and risk to the patient and the need to remove a nonfunctioning [tympanostomy tube] because of clogging. The benefit of a longer course of ototopicals may far exceed the risk of organism resistance and expense when considering the potential for additional surgery."

The authors have disclosed no relevant financial relationships.

JAMA Otolaryngol Head Neck Surg. Published online July 10, 2014. Abstract

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