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Risk Factors for Multiple Tympanostomy Tube Placements in Children: Systematic Review and Meta-Analysis
Alexander N Goel1, Aisosa Omorogbe1, Alyssa Hackett1
1Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
Insights
Approximately 24% of children require repeat tympanostomy tube (TT) placements, with craniofacial disease being a key predictor. Concurrent adenoidectomy and long-term tubes can reduce the need for repeat tympanostomy tube surgery.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Epidemiology
Background:
- Tympanostomy tubes (TT) are commonly placed in children to manage otitis media.
- Understanding the factors influencing repeat TT placements is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To determine the incidence of multiple tympanostomy tube (TT) placements in children.
- To identify predictors associated with repeat TT (r-TT) procedures.
Main Methods:
- A systematic review and meta-analysis of studies reporting risk factors for repeat TT placements.
- Searches were conducted in PubMed, EMBASE, and Cochrane Library databases.
- Data were synthesized using a random-effects model, adhering to PRISMA guidelines.
Main Results:
- Out of 290,897 children, 24.1% received at least two TT placements and 7.5% received three or more.
- Craniofacial disease (OR 5.13) was the strongest predictor for repeat TTs.
- Younger age at initial placement, shorter tube retention, concurrent adenoidectomy, and long-term tubes were significant factors.
Conclusions:
- Nearly one in four children undergo repeat tympanostomy tube insertions.
- Concurrent adenoidectomy and long-term tubes decrease the incidence of repeat TTs.
- Identifying at-risk children can enhance counseling and guide follow-up strategies.
Objectives/Hypothesis:
To determine the rate and predictors of receiving multiple tympanostomy tube (TT) placements in children.
Study Design:
Systematic review and meta-analysis.
Methods:
PubMed, EMBASE, and Cochrane Library databases were searched for studies reporting the risk factors for receiving repeat TT (r-TT) placements in children with chronic otitis media with effusion or recurrent acute otitis media. These articles were systematically reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. Data were pooled using a random-effects model.
Results:
Twenty-one studies involving a total of 290,897 children were included. Among all patients, 24.1% (95% confidence interval (CI), 18.2%-29.9%) underwent ≥2 TT placements and 7.5% (95% CI, 5.7%-9.4%) underwent ≥3 TT placements. Craniofacial disease (odds ratio (OR) 5.13, 95% CI, 1.57-16.74) was the strongest predictor of r-TT. Younger age at initial TT placement and shorter TT retention time were also significantly associated with r-TT. Receipt of primary adenoidectomy with initial TT placement was associated with decreased odds of r-TT (OR, 0.46; 95% CI, 0.39-0.55). Long-term tubes also significantly reduced the odds of r-TT (OR, 0.27; 95% CI, 0.17-0.44).
Conclusions:
About 1 in 4 children receiving TT will receive at least one repeat set of TT and about 1 in 14 will receive multiple repeat sets. Concurrent adenoidectomy and long-term tubes reduced the incidence of r-TT. Younger patients and those with earlier extrusion of the initial set are at increased risk for repeat surgery. The identification of these risk factors may improve parental counseling and identify patients who might benefit from closer follow-up.
Level Of Evidence:
NA Laryngoscope, 131:E2363-E2370, 2021.
