Risk Factors Associated With Postoperative Tympanostomy Tube Obstruction

Conrad, David E.; Levi, Jessica R.; Theroux, Zachary A.; Inverso, Yell; Shah, Udayan K.

doi:10.1001/jamaoto.2014.1176

Cited by 20 publications

(16 citation statements)

References 7 publications

(7 reference statements)

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“…Nonserious AEs were of type and rate consistent with expectations for tympanostomy procedures. For in‐office patients, otorrhea (6.0%) or tube occlusion (3.1%) rate by ear within the first month after the procedure was similar to rates reported in the literature, despite infrequent suction of effusion. This result is consistent with the literature suggesting that suction is not necessary to ensure a patent tube or reduce otorrhea rate .…”

Section: Discussionsupporting

confidence: 83%

In‐Office Tympanostomy Tube Placement in Children Using Iontophoresis and Automated Tube Delivery

et al. 2020

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Objectives/Hypothesis Evaluate technical success, tolerability, and safety of lidocaine iontophoresis and tympanostomy tube placement for children in an office setting. Study Design Prospective individual cohort study. Methods This prospective multicenter study evaluated in‐office tube placement in children ages 6 months through 12 years of age. Anesthesia was achieved via lidocaine/epinephrine iontophoresis. Tube placement was conducted using an integrated and automated myringotomy and tube delivery system. Anxiolytics, sedation, and papoose board were not used. Technical success and safety were evaluated. Patients 5 to 12 years old self‐reported tube placement pain using the Faces Pain Scale–Revised (FPS‐R) instrument, which ranges from 0 (no pain) to 10 (very much pain). Results Children were enrolled into three cohorts with 68, 47, and 222 children in the Operating Room (OR) Lead‐In, Office Lead‐In, and Pivotal cohorts, respectively. In the Pivotal cohort, there were 120 and 102 children in the <5 and 5‐ to 12‐year‐old age groups, respectively, with a mean age of 2.3 and 7.6 years, respectively. Bilateral tube placement was indicated for 94.2% of children <5 and 88.2% of children 5 to 12 years old. Tubes were successfully placed in all indicated ears in 85.8% (103/120) of children <5 and 89.2% (91/102) of children 5 to 12 years old. Mean FPS‐R score was 3.30 (standard deviation [SD] = 3.39) for tube placement and 1.69 (SD = 2.43) at 5 minutes postprocedure. There were no serious adverse events. Nonserious adverse events occurred at rates similar to standard tympanostomy procedures. Conclusions In‐office tube placement in selected patients can be successfully achieved without requiring sedatives, anxiolytics, or papoose restraints via lidocaine iontophoresis local anesthesia and an automated myringotomy and tube delivery system. Level of Evidence 2b Laryngoscope, 130:S1–S9, 2020

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Section: Discussionsupporting

confidence: 83%

In‐Office Tympanostomy Tube Placement in Children Using Iontophoresis and Automated Tube Delivery

et al. 2020

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“…3 Children with effusion at the time of tube insertion are more likely to develop tube obstruction at follow-up. 4 Early postoperative otorrhea and obstruction can lead to tube malfunction, continued hearing loss, and/or early extrusion of the tube and recurrent otitis media with effusion. 5 For these reasons, it is imperative to keep the tubes open and functional, especially in the immediate postoperative period.…”

Section: Introductionmentioning

confidence: 99%

Steroid Versus Antibiotic Drops in the Prevention of Postoperative Myringotomy Tube Complications

Alvi

Jones

Porter

et al. 2018

Ann Otol Rhinol Laryngol

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No significant difference in the incidence of immediate postoperative tympanostomy tube otorrhea or obstruction was seen between the antibiotic-steroid and antibiotic alone cohorts, regardless of effusion type. Overall, patients with mucoid effusions are more likely to develop tube otorrhea or obstruction at follow-up. Cost-effective drops should be used when prescribing topical therapy to prevent complications after ear tubes.

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“…Tube blockage in the early postoperative period (<30 days) may occur in up to 10% of TT and can be caused by cerumen, dried secretions, or clotted blood. 27,28 Strategies to prevent or treat obstruction include regular administration of antibiotic or combination antibiotic/steroid otic drops, intraoperative use of phenylephrine drops, or in-office debridement. 29,30 There are some limitations to this study.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Multiple Tympanostomy Tube Placements in Children: Systematic Review and Meta‐Analysis

et al. 2020

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Objectives/Hypothesis: To determine the rate and predictors of receiving multiple tympanostomy tube (TT) placements in children.Study Design: Systematic review and meta-analysis. Methods: PubMed, EMBASE, and Cochrane Library databases were searched for studies reporting the risk factors for receiving repeat TT (r-TT) placements in children with chronic otitis media with effusion or recurrent acute otitis media. These articles were systematically reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. Data were pooled using a random-effects model.Results: Twenty-one studies involving a total of 290,897 children were included. Among all patients, 24.1% (95% confidence interval (CI), 18.2%-29.9%) underwent ≥2 TT placements and 7.5% (95% CI, 5.7%-9.4%) underwent ≥3 TT placements. Craniofacial disease (odds ratio (OR) 5.13, 95% CI, 1.57-16.74) was the strongest predictor of r-TT. Younger age at initial TT placement and shorter TT retention time were also significantly associated with r-TT. Receipt of primary adenoidectomy with initial TT placement was associated with decreased odds of r-TT (OR, 0.46; 95% CI, 0.39-0.55). Long-term tubes also significantly reduced the odds of r-TT (OR, 0.27; 95% CI, 0.17-0.44).Conclusions: About 1 in 4 children receiving TT will receive at least one repeat set of TT and about 1 in 14 will receive multiple repeat sets. Concurrent adenoidectomy and long-term tubes reduced the incidence of r-TT. Younger patients and those with earlier extrusion of the initial set are at increased risk for repeat surgery. The identification of these risk factors may improve parental counseling and identify patients who might benefit from closer follow-up.

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Risk Factors Associated With Postoperative Tympanostomy Tube Obstruction

Abstract: Tympanostomy tube obstruction was seen in 10.6% of patients. Serous fluid and increased time to postoperative visit were statistically significant indicators for tube occlusion.

Cited by 20 publications

References 7 publications

In‐Office Tympanostomy Tube Placement in Children Using Iontophoresis and Automated Tube Delivery

In‐Office Tympanostomy Tube Placement in Children Using Iontophoresis and Automated Tube Delivery

Steroid Versus Antibiotic Drops in the Prevention of Postoperative Myringotomy Tube Complications

Risk Factors for Multiple Tympanostomy Tube Placements in Children: Systematic Review and Meta‐Analysis

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