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Risk factors associated with postoperative tympanostomy tube obstruction
David E Conrad1, Jessica R Levi2, Zachary A Theroux3
1Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware2Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
Insights
Tympanostomy tube obstruction affects 10.6% of pediatric patients. Serous middle ear fluid and delayed follow-up visits are key risk factors for blocked tympanostomy tubes.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Anesthesiology
Background:
- Myringotomy with tympanostomy tube placement is a common pediatric surgical procedure, often requiring anesthesia.
- Postoperative obstruction of tympanostomy tubes presents a challenge to middle ear ventilation, occurring in 1.4% to 36.0% of cases.
Purpose of the Study:
- To identify risk factors associated with tympanostomy tube obstruction following myringotomy and tube placement.
- To understand the impact of fluid type and follow-up timing on tube patency.
Main Methods:
- Retrospective review of 248 pediatric patients undergoing tympanostomy tube placement.
- Analysis of factors including middle ear fluid type, body mass index (BMI), sex, surgical procedure type, and time to follow-up.
Main Results:
- Tube obstruction was observed in 10.6% of patients at the first postoperative visit.
- Serous middle ear fluid (OR, 3.5) and longer intervals between surgery and follow-up (OR per day, 0.990) were significantly associated with increased risk of tube occlusion.
- No significant association was found with BMI, sex, or surgical procedure type.
Conclusions:
- Tympanostomy tube obstruction is a notable complication, affecting over 10% of pediatric patients.
- The presence of serous middle ear fluid and delayed postoperative follow-up are significant predictors of tympanostomy tube occlusion.
- These findings highlight the importance of monitoring fluid status and timely follow-up to ensure middle ear ventilation.
Importance:
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. Postoperative tube obstruction occurs in 1.4% to 36.0% of cases and remains a challenge in achieving middle ear ventilation.
Objective:
To identify risk factors associated with tube obstruction.
Design, Setting, And Participants:
Retrospective medical record review of 248 patients, mean age 2.54 years, seen between March 2007 and June 2011 in a tertiary care pediatric hospital.
Interventions:
Tympanostomy tube placement and postoperative otic drop therapy.
Main Outcomes And Measures:
Tube patency at postoperative visit, number of tube removals and revisions, age, sex, body mass index (BMI), middle ear fluid type at time of surgery, and time between surgery and first postoperative visit were examined. Type of surgery (tympanostomy tube placement alone, adenoidectomy + tympanostomy tube placement, tympanostomy tube placement + adenoidectomy + tonsillectomy) and its effect on tube patency were also reviewed.
Results:
At first follow-up, 10.6% of patients had occlusion of one or both tubes. No significant association was found between tube patency and a patient's BMI percentile, sex, or procedure type. Patients with no middle ear fluid were more likely to have patent tubes than those who had serous fluid (odds ratio [OR], 3.5; 95% CI, 1.2-10.6; P = .02). A significant inverse correlation was found between patency and time between surgery and follow-up in that patients who had longer follow-up after surgery were less likely to have patent tubes (OR per day of follow-up delay, 0.990; 95% CI, 0.981-0.999; P = .01).
Conclusions And Relevance:
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.
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