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Refractory tympanostomy tube otorrhea: Outcomes with otowick placement
Diya Ramanathan1, Eugene Postevka2, Nikhila Raol3
1Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Insights
Otowick placement significantly reduces the duration of refractory otorrhea in pediatric patients compared to medical therapy or tube removal. This suggests otowicks may be a beneficial first-line treatment option.
Area of Science:
- Pediatric Otolaryngology
- Infectious Diseases of the Ear
Background:
- Refractory otorrhea, defined as ear discharge lasting at least two weeks, is a common complication following tympanostomy tube placement in children.
- Current management strategies include medical therapy and surgical interventions like tube removal and replacement, which can be burdensome and carry risks.
Purpose of the Study:
- To compare the efficacy of otowick placement versus traditional medical therapy and tympanostomy tube removal/replacement in resolving refractory otorrhea in pediatric patients.
- To evaluate antibiotic use and duration of otorrhea episodes across different treatment groups.
Main Methods:
- A retrospective cohort study was conducted on 70 pediatric patients with refractory otorrhea treated between 2017 and 2022.
- Data collected included patient demographics, antibiotic treatments, otorrhea duration, and resolution rates at 1 and 3 months.
- Statistical analyses included Wilcoxon rank sum, Kruskal-Wallis, ANOVA, and Fisher's exact tests.
Main Results:
- Otowick placement resulted in a statistically significant decrease in the total duration of otorrhea (17.29 days) compared to medical therapy (27.09 days) and tube removals/replacements (29.63 days) (p=0.025).
- No significant differences were observed in otorrhea resolution rates at 1 month (p=1) or 3 months (p=0.12) between the groups.
- The study included 37 males and 33 females, with an average age of 29.66 months at tympanostomy tube placement.
Conclusions:
- Otowick use is associated with a shorter duration of refractory otorrhea and can be considered a primary treatment option.
- Utilizing otowicks or medical therapy alone may reduce the necessity for tympanostomy tube removals, thereby decreasing the risks associated with anesthesia.
Objective:
To evaluate rates of resolution of and antibiotic use in refractory otorrhea (otorrhea ≥2 weeks with no more than 2 days of otorrhea resolution during the episode) with otowick placement in comparison to medical therapy and tube removals with or without replacements.
Study Design:
Retrospective cohort study of pediatric patients with a history of tympanostomy tube placement and refractory otorrhea between 2017 and 2022.
Setting:
Cleveland Clinic Foundation (CCF) pediatric otolaryngology group.
Methods:
Demographic data (sex, race, and age at tympanostomy tube placement) were collected. Outcome measures included number of oral and topical antibiotic treatments, duration of otorrhea episode, and resolution of otorrhea at 1 and 3 months follow-up. Wilcoxon rank sum and Kruskal-Wallis tests were used to compare number of antibiotics treatments. An ANOVA test and linear regression model using log-transformed data were used to compare duration of otorrhea. Fisher's exact test was used to compare rates of otorrhea recurrence.
Results:
70 patients met inclusion criteria: 37 male (52.9%), 33 female (47.1%), with an average age at tube placement of 29.66 months. There was a statistically significant decrease in total duration of otorrhea (in days) with otowicks (17.29 ± 13.13), compared to patients receiving medical therapy (27.09 ± 22.02) and tube removals and replacements (29.63 ± 19.95) (p = 0.025). There was no significant difference between the follow-up rates of resolution at 1 month (p = 1) and 3 months (p = 0.12).
Conclusion:
Otowick use is associated with shorter duration of otorrhea and can be considered as a first-line treatment for refractory otorrhea. Otowicks and medical therapy alone can reduce need for tube removals and the associated risk of anesthesia.
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