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Long-term Impact of Middle Ear Effusion in Pediatric Tympanostomy Tubes
Thomas M Kaffenberger1, Michael A Belsky2, Nicholas R Oberlies2
1Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.
Objectives/Hypothesis:
Bilateral myringotomy and tympanostomy tube placement (BMT) is the most common pediatric surgery in the United States. Intraoperative middle ear effusion (MEE) is a risk factor for future BMTs in children with recurrent acute otitis media (RAOM). However, the impact of the type of MEE is unknown. Here, we assess otologic outcomes based on intraoperative MEE type and indication for surgery.
Study Design:
Case series chart review.
Methods:
After institutional review board approval, we performed a review of children undergoing BMTs between 2008 and 2009. Included patients had their first BMT, preoperative visit, and an operative report. Patients with cleft palate or Down syndrome were excluded. Indications for surgery included RAOM and chronic otitis media with effusion (COME). Other variables evaluated were future BMT, acquired cholesteatoma, and otorrhea. Logistic regression was used for statistical analysis.
Results:
Out of 1,045 patients reviewed, 680 were included and underwent their first BMT. There were 619 patients who had RAOM. Serous effusions were present in 22.2%, mucoid in 31.3%, purulent in 12.9%, undocumented or bloody in 2.3% of patients, and 31.2% of patients had dry middle ears. Moreover, 22.7% of patients underwent future BMTs. In RAOM patients, serous effusions decreased odds of perforation (odds ratio [OR]: 0.195, 95% confidence interval [CI]: 0.0438-0.867, P = .032), and purulent effusions increased the odds of in-office otorrhea suctioning (OR: 2.13, 95% CI: 1.20-3.77, P = .010) compared to dry. Mucoid effusions had no significant effect on outcomes in COME or RAOM patients.
Conclusions:
Intraoperative MEEs were noted in 68.7% of cases; purulent effusions increase the odds of in-office suctioning in RAOM patients.
Level Of Evidence:
4 Laryngoscope, 131:E993-E997, 2021.
Insights
Middle ear effusion type impacts outcomes in pediatric ear surgery. Purulent effusions increase the need for suctioning in children with recurrent acute otitis media (RAOM), while serous effusions may reduce perforation risk.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Otitis Media Research
Background:
- Bilateral myringotomy and tympanostomy tube placement (BMT) is a common pediatric procedure.
- Intraoperative middle ear effusion (MEE) is a known risk factor for subsequent BMTs in children with recurrent acute otitis media (RAOM).
- The specific impact of different MEE types on surgical outcomes remains unclear.
Purpose of the Study:
- To evaluate the association between intraoperative middle ear effusion (MEE) characteristics and otologic outcomes.
- To determine if MEE type influences the need for future BMTs or other complications.
- To analyze outcomes based on MEE type and surgical indication (RAOM vs. chronic otitis media with effusion [COME]).
Main Methods:
- Retrospective chart review of 1,045 pediatric patients undergoing their first BMT between 2008-2009.
- Inclusion criteria: first BMT, preoperative visit, operative report; exclusion: cleft palate, Down syndrome.
- Logistic regression analysis was used to assess the impact of MEE type on outcomes like future BMTs, cholesteatoma, and otorrhea.
Main Results:
- Of 680 included patients, 68.7% had intraoperative MEE.
- Serous effusions in RAOM patients were associated with decreased odds of perforation (OR: 0.195).
- Purulent effusions in RAOM patients increased odds of in-office otorrhea suctioning (OR: 2.13) compared to dry ears. Mucoid effusions showed no significant outcome association.
Conclusions:
- Intraoperative middle ear effusion characteristics influence otologic outcomes in pediatric BMT surgery.
- Purulent MEE is linked to increased need for otorrhea suctioning in RAOM cases.
- Serous MEE may offer a protective effect against perforation in RAOM patients.
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