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Reduction of Antibiotic-Associated Conditions After Tympanostomy Tube Placement in Children
Sivakumar Chinnadurai1,2, Cassandra Meyer1,3, Brianne Roby1,2
1ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, USA.
Insights
Tympanostomy tubes reduce antibiotic use in children with recurrent ear infections. This placement is linked to lower rates of obesity, asthma, and allergies later in life.
Area of Science:
- Pediatric Otolaryngology
- Public Health
- Epidemiology
Background:
- Recurrent acute otitis media (RAOM) in children often leads to increased systemic antibiotic use.
- Systemic antibiotics in childhood are linked to various later-life health conditions, including asthma, allergies, and obesity.
- Tympanostomy tube placement is a common intervention for RAOM.
Purpose of the Study:
- To determine if tympanostomy tube placement is associated with a reduction in antibiotic-associated conditions in children with RAOM.
- To evaluate the long-term health outcomes following tympanostomy tube insertion for RAOM.
Main Methods:
- Retrospective cohort review of 27,584 pediatric patients with RAOM (≥3 acute otitis media episodes).
- Electronic medical records from 1991-2011 from a large pediatric hospital system were analyzed.
- Antibiotic-associated conditions were identified using ICD-9 and ICD-10 codes.
Main Results:
- Children receiving tympanostomy tubes had significantly lower systemic antibiotic prescriptions per encounter (0.14 vs. 0.23).
- Tympanostomy tube recipients showed reduced likelihood of overweight/obesity (OR 0.62), asthma (OR 0.8), allergic rhinitis (OR 0.72), and atopic dermatitis (OR 0.78).
Conclusions:
- Tympanostomy tube placement in children with RAOM is associated with decreased systemic antibiotic administration.
- The procedure is linked to a lower incidence of overweight/obesity, asthma, allergic rhinitis, and atopic dermatitis in this pediatric population.
Objective:
Tympanostomy tube placement has been shown to decrease systemic antibiotics usage in patients with recurrent acute otitis media. Systemic antibiotics in children are associated with an increase in antibiotic-associated conditions (asthma, allergic rhinitis, food allergy, atopic dermatitis, celiac disease, overweight/obesity, attention-deficit hyperactivity disorder [ADHD], autism, learning disability, and Clostridium difficile colonization) later in life. The objective of this study is to estimate whether tympanostomy tube placement is associated with a reduction in antibiotic-associated conditions in children with recurrent acute otitis media (RAOM).
Methods:
A retrospective cohort review of electronic medical records from 1991 to 2011 at a large pediatric hospital system was performed identifying 27,584 patients under 18 years old with RAOM, defined by 3 or more episodes of AOM. Antibiotic-associated conditions were defined using ICD-9 and ICD-10 codes.
Results:
The enrollment population was largely composed of White patients (28.9%), Black patients (30.1%), and Hispanic/Latino patients (16.4%). The number of systemic antibiotics prescribed per encounter was significantly lower in children who pursued tympanostomy tubes (0.14 antibiotics per encounter) versus those who did not (0.23 antibiotics per encounter) (p < 0.001). Patients with RAOM who received tympanostomy tubes were less likely to have diagnoses of overweight/obesity (OR. 0.62 [0.55, 0.68]; p < 0.001), asthma (OR 0.8 [0.74, 0.87]; p < 0.001), allergic rhinitis (OR 0.72 [0.65, 0.81]; p < 0.001), and atopic dermatitis (0.78 [0.71, 0.86]; p < 0.001).
Conclusions And Relevance:
Tympanostomy tube placement is associated with less systemic antibiotic administration and a decreased incidence of overweight/obesity, asthma, allergic rhinitis, and atopic dermatitis in children diagnosed with RAOM.
Level Of Evidence:
4 Laryngoscope, 135:423-428, 2025.
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