[Factors Related to Tympanic Membrane Perforation in Children with Acute Suppurative Otitis Media]
Chao-Yun Xie1,2, Dong Chen1,2, Fu-Xiang Liu1,2
1Department of Infection Management,Guizhou 558000,China.
Insights
Tympanic membrane perforation in children with acute suppurative otitis media is linked to factors like infection duration and type. Early, targeted antibiotic treatment and managing co-existing conditions can reduce perforation incidence.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Medical Microbiology
Background:
- Acute suppurative otitis media (ASOM) is a common childhood infection.
- Tympanic membrane perforation (TMP) is a potential complication of ASOM.
- Understanding risk factors for TMP is crucial for effective clinical management.
Purpose of the Study:
- To identify factors associated with tympanic membrane perforation in children diagnosed with acute suppurative otitis media.
- To provide data-driven insights for improving clinical practices in managing ASOM.
Main Methods:
- Retrospective review of clinical data from 1274 children with ASOM (February 2017 - May 2020).
- Univariate and multivariate logistic regression analyses were performed to identify risk factors for TMP.
- Statistical significance was determined using p-values and confidence intervals.
Main Results:
- The incidence of TMP in the study cohort was 5.27% (67 out of 1274 children).
- Independent risk factors for TMP included longer onset duration, upper respiratory tract infection, chronic sinusitis, tympanic empyema, and delayed antibiotic selection based on drug sensitivity.
- Several other factors showed significant associations in univariate analysis.
Conclusions:
- Key factors contributing to TMP in children with ASOM include infection duration, co-existing infections (URTI, sinusitis), tympanic empyema, and delayed antibiotic therapy.
- Strategies to reduce TMP incidence involve early diagnosis and treatment, maintaining Eustachian tube patency, tympanic cavity drainage, and prompt, sensitivity-guided antibiotic selection.
Abstract:
Objective To explore the factors related to tympanic membrane perforation in children with acute suppurative otitis media,and to provide reference for clinical practice. Methods We reviewed the clinical data of 1274 children with acute suppurative otitis media from February 2017 to May 2020,and analyzed the factors related to tympanic membrane perforation. Results Tympanic membrane perforation occurred in 67 out of the 1274 children with acute suppurative otitis media,with the incidence of 5.27%.The univariate analysis showed that 11 factors including the duration of onset(t=2.381,P=0.017),upper respiratory tract infection(χ2=12.228,P=0.000),pulmonary infection(χ2=5.242, P=0.022),chronic sinusitis(χ2=12.715,P=0.000),adenoid hypertrophy(χ2=4.783,P=0.029),tympanic empyema(χ2=16.020,P=0.000),the duration of using antibiotics(t=-2.277,P=0.025),combined use of antibiotics(χ2=5.587,P=0.018),the time from onset to selection of antibiotics according to drug sensitivity(t=3.716,P=0.000),procalcitonin(t=2.599,P=0.009),and white blood cell count in peripheral blood(t=2.196,P=0.031)were related to tympanic membrane perforation in children with acute suppurative otitis media.The multivariate logistic analysis showed that the duration of onset(OR=4.854,95% CI=2.675-8.806,P=0.000),upper respiratory tract infection(OR=6.506,95% CI=3.213-13.171,P=0.000),chronic sinusitis(OR=7.866,95% CI=3.780-16.370,P=0.000),tympanic empyema(OR=2.625,95% CI=1.442-4.777,P=0.002),and time from onset to selection of antibiotics according to drug sensitivity(OR=5.107,95% CI=2.129-12.248,P=0.000)were independent risk factors for tympanic membrane perforation in children with acute suppurative otitis media. Conclusion The incidence of tympanic membrane perforation in children with acute suppurative otitis media can be reduced by early treatment,keeping the Eustachian tube unobstructed,draining the tympanic cavity,preventing chronic sinusitis and upper respiratory tract infection,early drug sensitivity test,and selection of antibiotics based on the test results.
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