Contemporary Tympanostomy Tube Complications in Children: A Population-Based Longitudinal Study

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Public Health

Background:

• Pediatric otitis media management relies on tympanostomy tube insertion (TTI).
• Previous TTI complication rates (2001) reported otorrhea (16–26%), cholesteatoma (0.7%), and tympanic membrane perforation (TMP) (2.2–16%).
• Global interventions have aimed to reduce pediatric otitis media burden since 2001.

Purpose of the Study:

• To quantify current tympanostomy tube insertion (TTI) complication rates within 3 years post-surgery.
• To compare complication rates between younger (0–6 years) and older (7–18 years) pediatric age groups.
• To establish updated benchmarks for TTI outcomes in the post-intervention era.

Main Methods:

• Population-based longitudinal study utilizing a national healthcare database (2005–2021).
• Included children undergoing TTI with 3-year follow-up; excluded those with prior otological surgery or craniofacial anomalies.
• Complications assessed included: TT removal, otorrhea, TMP, cholesteatoma, and mastoidectomy.

Main Results:

• Of 19,920 children, 86.6% were younger than 7 years.
• Older children had significantly higher rates of TMP (6.9% vs 3.3%), TT removal (5.1% vs 3.8%), cholesteatoma (2.2% vs 0.8%), and mastoidectomy (0.8% vs 0.3%).
• Younger children experienced higher otorrhea rates (11% vs 6.4%) but for a shorter duration.

Conclusions:

• TTI complication rates have generally decreased in the post-intervention era.
• Cholesteatoma development remains a notable exception with elevated rates.
• Updated complication data aid in managing patient and caregiver expectations following TTI.