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Factors associated with retained tympanostomy tubes a case-controlled study
Mikayla J Huestis1, Jennifer N Shehan2, Jessica R Levi2
1Affiliated with Boston University School of Medicine, USA.
Insights
Recurrent otitis media as the sole reason for tympanostomy tubes may increase the risk of tubes being retained. This finding aids in counseling parents about potential risks and outcomes.
Area of Science:
- Otolaryngology
- Pediatric Otology
- Surgical Outcomes Research
Background:
- Tympanostomy tubes are commonly inserted in children to manage otitis media.
- Tube extrusion typically occurs within 6-18 months, but some tubes are retained longer.
- Retained tympanostomy tubes may necessitate surgical removal and can be associated with complications.
Purpose of the Study:
- To identify factors associated with retained tympanostomy tubes.
- To enhance parent counseling regarding the risks and outcomes of tympanostomy tube insertion.
Main Methods:
- A case-control study was conducted using retrospective chart review from 2012-2019.
- Cases of retained tympanostomy tubes (in place >2 years) were compared to controls with confirmed extrusion.
- Factors analyzed included indication for tube insertion, infection history, tube duration, and prior adenoidectomy.
Main Results:
- 46 cases and 92 controls were analyzed. Cases had significantly longer tube duration (median 3.27 years vs 1.61 years).
- Recurrent otitis media as the sole indication for tube placement was significantly more likely in cases (OR 2.36).
- A logistic regression model showed high specificity (98.91%) but low sensitivity (9.09%) for predicting retained tubes based on indication and multiple tube sets.
Conclusions:
- Recurrent otitis media as the sole indication for tympanostomy tube placement may be a risk factor for tube retention.
- These findings can inform more precise risk-benefit discussions with parents regarding tympanostomy tube procedures.
Objective:
To determine factors associated with retained tympanostomy tubes in order to improve parent counseling on procedure risks and outcomes.
Methods:
This is a case-control study; we conducted a retrospective chart review from 2012 to 2019 of cases of retained tympanostomy tubes compared to controls with confirmed tympanostomy tube extrusion. The study was conducted at a single tertiary care center, Boston Medical Center. A retained tympanostomy tube was defined as in place for more than two years requiring removal in the operating room. Cases were matched to two controls and assessed for the following factors: indication for tympanostomy tube insertion, frequency of otitis media and otorrhea after tympanostomy tube insertion, duration tympanostomy tubes were in place, numbered set of tympanostomy tubes, sinopulmonary conditions, and adenoidectomy status prior to tympanostomy tube removal or extrusion.
Results:
46 cases were identified and matched to 92 controls. Cases had a significantly longer tympanostomy tube duration (3.273, IQR 1.099 vs 1.611, IQR 0.894 years, p < 0.001). The indication for tympanostomy tube placement for cases compared to controls was significantly more likely to be recurrent otitis media only (odds ratio 2.36, CI 1.121 to 5.003). A multiple logistic regression model was performed with the indication for tympanostomy tube placement (chronic or recurrent otitis media) and a history of more than two sets of tympanostomy tubes. The model had a low sensitivity, 9.09%, and high specificity, 98.91%.
Conclusion:
Patients whose only indication for surgery is recurrent otitis media are possibly at higher risk for retained tympanostomy tubes that require removal in the operating room.
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