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Published on: May 23, 2021
Outcomes of Mastoidectomy With Antibiotic Catheter Irrigation for Patients With Draining Ventilation Tubes
Joel W Jones1,2, Daniel P Ballard1, Todd A Hillman1
1Pittsburgh Ear Associates, Allegheny General Hospital, Pittsburgh, PA, USA.
Objectives:
To evaluate the effectiveness of mastoidectomy with antibiotic catheter irrigation in patients with chronic tympanostomy tube otorrhea.
Methods:
A chart review of adult and pediatric patients with persistent tympanostomy tube otorrhea who had failed outpatient medical management and underwent mastoidectomy with placement of a temporary indwelling catheter for antibiotic instillation was performed. Patients were retrospectively followed for recurrent drainage after 2 months and outcomes were categorized as resolution (0-1 episodes of otorrhea or otitis media with effusion during follow-up), improvement (2-3 episodes), or continued episodic (>3 episodes).
Results:
There were 22 patients and 23 operated ears. Median age was 46 years (interquartile range, IQR = 29-65). The median duration of otorrhea from referral was 5.5 months (IQR = 2.8-12). Following surgery, 14 ears had resolution of drainage, 6 had improvement, and 3 had episodic. The observed percentage of resolved/improved ears (87%) was significant (P = .0005, 95% CI = 67.9%-95.5%). Median follow-up time was 25 months (IQR = 12-59). Pre and postoperative pure tone averages improved (difference of medians = -3.3 dB, P = .02) with no significant difference in word recognition scores (P = .68). Methicillin-resistant Staphylococcus aureus was the most common isolated microbe while no growth was most frequently noted on intraoperative cultures.
Conclusions:
Mastoidectomy with antibiotic catheter irrigation may be an effective surgical strategy, and single stage alternative to intravenous antibiotics, for select patients with persistent tube otorrhea who have failed topical and oral antibiotics.
Insights
Mastoidectomy with antibiotic catheter irrigation effectively treated chronic tympanostomy tube otorrhea in 87% of patients who failed other treatments. This surgical approach improved hearing outcomes and offers a single-stage alternative to intravenous antibiotics.
Area of Science:
- Otolaryngology
- Surgical Innovation
- Infectious Disease Management
Background:
- Chronic tympanostomy tube otorrhea is a common complication of middle ear ventilation.
- Persistent otorrhea often requires advanced treatment strategies beyond topical and oral antibiotics.
- Failed medical management necessitates evaluation of surgical interventions.
Purpose of the Study:
- To assess the efficacy of mastoidectomy combined with antibiotic catheter irrigation for chronic tympanostomy tube otorrhea.
- To determine if this surgical approach leads to resolution or improvement of otorrhea.
- To evaluate the impact on hearing function and identify common microbial pathogens.
Main Methods:
- Retrospective chart review of adult and pediatric patients with persistent tympanostomy tube otorrhea.
- Inclusion criteria: failure of outpatient medical management, undergoing mastoidectomy with antibiotic catheter placement.
- Outcomes assessed: resolution, improvement, or episodic otorrhea post-surgery; hearing thresholds and word recognition scores evaluated.
Main Results:
- Out of 23 operated ears, 87% showed resolution (14 ears) or improvement (6 ears) of otorrhea (P = .0005).
- Median follow-up was 25 months; pre- and postoperative pure tone averages improved (P = .02).
- Methicillin-resistant Staphylococcus aureus was frequently isolated; no growth was common in cultures.
Conclusions:
- Mastoidectomy with antibiotic catheter irrigation is an effective surgical option for select patients with refractory chronic tympanostomy tube otorrhea.
- This single-stage procedure may serve as an alternative to intravenous antibiotics.
- The technique demonstrates positive outcomes in otorrhea resolution and hearing improvement.
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