Bacteria and granulation tissue associated with Montgomery T-tubes

Area of Science:

• Otolaryngology
• Microbiology
• Biomaterials Science

Background:

• Complications of silicone Montgomery T-tubes, including infection and granulation tissue, are known.
• The microbiological basis and origin of granulation tissue associated with these devices remain unevaluated.

Purpose of the Study:

• To evaluate the microbiological consequences of silicone Montgomery T-tube use.
• To investigate the origin of granulation tissue formation around these T-tubes.

Main Methods:

• Prospective trial analyzing 23 Montgomery T-tubes from 10 patients.
• Assessment of granulation tissue, bacterial growth (including genotyping via polymerase chain reaction), and antibiotic sensitivity.
• Investigation of stent sterilization efficacy.

Main Results:

• Granulation tissue was present in 74% of stents; all showed infection, with no foreign body reaction.
• Staphylococcus aureus (35%) and Pseudomonas aeruginosa (17%) were predominant pathogens.
• Polymerase chain reaction (PCR) genotyping revealed persistent Staphylococcus aureus colonization in one patient over 15 months.
• Antibiotic sensitivity testing indicated effectiveness of amoxicillin-clavulanate and ofloxacin combination (65%).
• Sterilization achieved 92% bacterial clearance in analyzed stent segments.

Conclusions:

• Granulation tissue commonly forms adjacent to silicone T-tubes, linked to Staphylococcus aureus and Pseudomonas aeruginosa.
• A combination of mechanical irritation and bacterial infection likely causes granulation tissue.
• PCR genotyping demonstrated persistent and changing bacterial colonization patterns.
• Amoxicillin-clavulanate and ofloxacin combination is the most effective antibiotic therapy.
• Sterilization of silicone T-tubes is feasible, supporting cost-effective reuse in patients.