Anatomic and audiologic sequelae after tympanostomy tube insertion or prolonged antibiotic therapy for otitis media

In this study the anatomic and hearing sequelae are characterized for 43 children (86 ears) with recurrent acute otitis media and/or persistent otitis media with effusion who had received three or more tympanostomy tube placements and 46 children (92 ears) managed medically with repeated courses of therapeutic and/or or prophylactic antibiotics. In the surgical group 311 tympanostomy tube surgeries had been performed and in the medical group 1334 episodes of acute otitis media and/or 186 episodes of otitis media with effusion occurred. Tympanosclerosis was found in 6.5% of the medical group ears and 52.3% of the surgical group ears. Tympanic atrophy occurred in 4.3% of the medical group ears and 40.7% of the surgical group ears. The duration of the presence of the tympanostomy tube significantly influenced the tympanic membrane. The presence of middle ear fluid at the time of tube insertion, particularly high viscosity ("glue") fluid, correlated with persisting sclerosis (P less than 0.00001) and reduced tympanic membrane mobility (P less than 0.00001) but not tympanic membrane atrophy (P = 0.94) later. Abnormal hearing, defined as a hearing threshold greater than 20 dB occurred in 9.3 to 18.7% of the surgical ears and in 3.7 to 9.0% of the medical ears depending on the hearing frequency tested. Medical management consisting of recurrent use of therapeutic and/or prophylactic antibiotics was associated with infrequent anatomic and audiologic sequelae. Repeated placement of tympanostomy tubes may be associated with the frequent occurrence of both anatomic and audiologic sequelae.