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Updated: Mar 22, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Variables associated with repeated ventilation tube insertion in healthy non-syndromic children
Han Zhang1, Yaser Alrajhi2, Hamdy El-Hakim2
1Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
Insights
Children with recurrent acute otitis media (rAOM) or otitis media with effusion (OME) may need bilateral ventilation tubes (rVT) if they attend large daycares, have atelectatic tympanic membranes, or if parents smoke. Not being breastfed for at least three months also increases risk.
Area of Science:
- Otolaryngology
- Pediatric Medicine
- Epidemiology
Background:
- Recurrent acute otitis media (rAOM) and otitis media with effusion (OME) are common pediatric conditions.
- Bilateral ventilation tube (rVT) insertion is a treatment option for persistent or recurrent middle ear infections.
- Identifying risk factors for rVT insertion is crucial for optimizing treatment strategies.
Purpose of the Study:
- To determine variables associated with bilateral ventilation tube (rVT) insertions for recurrent acute otitis media (rAOM) and/or otitis media with effusion (OME) in otherwise healthy children.
- To identify predictors for the need for bilateral ventilation tubes in pediatric otitis media cases.
Main Methods:
- Retrospectively controlled cohort study design.
- Patients identified from a prospectively collected surgical database.
- Inclusion of subjects who underwent rVT and a control group with single ventilation tube (VT) insertion; exclusion of children with craniofacial abnormalities or syndromes.
- Collection of data on demographics, tympanic membrane characteristics, parental smoking, breastfeeding history, daycare attendance, and soother use.
Main Results:
- Over 10 years, 59 patients underwent rVT (5.6%) compared to 180 in the control group.
- Significant associations found for rVT insertion: parental smoking (OR 61.8), large daycare attendance (OR 23.39), breastfeeding <3 months (OR -0.074), soother use (OR 21.49), and tympanic membrane atelectasis (p<0.0005).
- These factors remained significant in multiple regression analysis (p<0.05).
Conclusions:
- Otherwise healthy children with rAOM and/or OME are at increased risk for rVT if they attend large daycares.
- Inadequate breastfeeding (<3 months) and tympanic membrane atelectasis are associated with higher rates of rVT insertion.
- Parental smoking is the most significant factor associated with the need for bilateral ventilation tubes in this pediatric population.
Objectives:
The objectives of this study was to determine variables associated with rVT insertions for rAOM and/or OME in otherwise healthy children.
Methods:
This was designed as a retrospectively controlled cohort study. Patients were identified from a prospectively collected surgical database. Eligible subjects were those who had undergone rVT and a consecutive concurrent control group who received only one ventilation tube (VT). Exclusion criteria included craniofacial abnormalities and syndromes. Demographics, tympanic membrane characteristics, parental smoking, breast-feeding history, large day-care attendance, and soother use was collected.
Results:
Over a period of 10 years, 59 patients underwent rVT (5.6%). 180 children who underwent VT were included in the control group. There was no difference in gender distribution (p=1, 1.73:1 vs. 1.76:1), mean age (p=0.69, 4.7±3.33 vs. 4.4±3.17) or chronic rhinitis (p=0.36, OR 1.376, 95% CI: 0.69-2.74). The rVT group was associated significantly more with a smoking parent (p=0, OR 61.8, 95% CI 21.26-176.07), large day care attendance (p=0, OR 23.39, 95% CI: 8.637-57.54), breast feeding <3months (p=0, OR -0.074, 95% CI: 0.028-0.331), soother use (p=0, OR 21.49, 95% CI: 7.81-55.87), and tympanic membrane atelectasis (p<0.0005). The same factors were also found to be significant upon multiple regression analysis (p<0.05).
Conclusions:
Otherwise healthy children with rAOM and/or OME are at a greater risk of rVT if they attend large day cares, were not breast fed for ≥3 months, if their tympanic membranes were atelectatic and most significantly if their parents smoke.
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