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Epidemiology of Persistent Tympanic Membrane Perforations Subsequent to Tympanostomy Tubes Assessed With Real World
Adel Alrwisan1, Almut G Winterstein, Patrick J Antonelli
1*Department of Pharmaceutical Outcomes and Policy, College of Pharmacy†Department of Epidemiology, College of Public Health and Health Professions and College of Medicine‡Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, Florida.
Insights
This study found that persistent tympanic membrane perforation (TMP) after tympanostomy tube (TT) surgery is more likely with reinsertions and increases with age. Billing data can track TMP rates in large populations.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Epidemiology
Background:
- Tympanostomy tubes (TTs) are commonly placed in children to manage otitis media.
- Persistent tympanic membrane perforation (TMP) is a potential complication following TT insertion.
- Quantifying the incidence of persistent TMP is crucial for understanding TT surgery outcomes.
Purpose of the Study:
- To determine the incidence of persistent tympanic membrane perforation (TMP) after tympanostomy tube (TT) surgery.
- To utilize a large, population-based cohort for accurate incidence quantification.
Main Methods:
- Retrospective cohort study using Medicaid claims data from 1999 to 2006.
- Included healthy children receiving TTs with 2 to 7 years of follow-up.
- Persistent TMP operationalized by tympanoplasty charges and/or TMP diagnoses.
Main Results:
- The 7-year incidence of persistent TMP varied from 0.52% to 3.81% based on definition.
- Reinserting TTs significantly increased the likelihood of persistent TMP (aHR = 1.98).
- Each additional year of age increased the risk of persistent TMP by 49%.
Conclusions:
- Medicaid claims data effectively assess persistent TMP rates in large populations.
- Findings align with existing cohort studies and meta-analyses.
- This study provides a basis for future real-world data research on TMP.
Objective:
To quantify the incidence of persistent tympanic membrane perforation (TMP) after tympanostomy tube (TT) surgery using a large population-based cohort.
Study Design:
A retrospective cohort study.
Setting:
Medicaid claims data from 1999 to 2006.
Patients:
We studied healthy children who had Medicaid eligibility within 6 months of birth that received TTs and had 2 to 7 years of follow-up.
Main Outcome Measures:
We operationalized persistent TMP by a charge for tympanoplasty and/or one or more diagnoses of TMP.
Results:
We identified 47,724 children who received TTs and had ≥2 years eligibility. The incidence of persistent TMP varied, based on definition and follow-up. The 2 and 7-year TMP rates were: 0.38% and 3.81% for two TMP diagnoses 6 months apart or tympanoplasty; 0.26% and 2.94% for two TMP diagnoses 6 months apart; 0.13% and 1.73% for tympanoplasty, alone; 0.04% and 1.21% for tympanoplasty preceded by one TMP diagnosis; and 0.01% and 0.52% for tympanoplasty and two TMP diagnoses 6 months apart. Reinserting TTs was associated with an increased likelihood of persistent TMP (adjusted hazard ratio [HR] = 1.98, 95% CI 1.49-2.63). Each year increase in age was associated with 49% increase in the risk of persistent TMP.
Conclusion:
Billing claims data may be used to assess the rate of persistent TMP after TT placement in large populations, yielding results consistent with findings from cohort studies and meta-analyses. Our findings may serve as the basis for future TMP research using real world datasets.
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