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Contemporary Tympanostomy Tube Complications in Children: A Population-Based Longitudinal Study
Insights
Tympanostomy tube insertion (TTI) complication rates have decreased in the post-intervention era, though cholesteatoma rates remain elevated. This study provides current data to help patients and caregivers set realistic expectations for TTI outcomes.
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.
Objective:
To describe the current tympanostomy tube insertion (TTI) complication rates occurring within 3 years of surgery in the post-intervention era. Current TTI complication rates in children are based on reports from a meta-analysis that was published in 2001, reporting on 16 to 26% otorrhea rates, cholesteatoma development of 0.7%, and tympanic membrane perforation (TMP) of 2.2 to 16%. Since then, interventions aimed at reducing pediatric otitis media burden have been largely implemented worldwide, and indications for TTI have been published.
Study Design:
Population-based longitudinal study. Data were anonymously retrieved from a big stable healthcare database between 2005 and 2021.
Setting:
Hospitals and ambulatory surgical centers, nationwide.
Patients:
Children who underwent TTI and completed 3 postoperative follow-up years within the health insurance. We excluded children with previous otological surgery and congenital craniofacial anomalies. Children were categorized into the younger (0-<7 yr) and older (7-18 yr) age groups.
Intervention:
TTI (therapeutic).
Main Outcome Measures:
Number of TTI performed per 100,000 children per study year, and cumulative incidence of these postoperative complications: TT removal, otorrhea, TMP, cholesteatoma development, and need for mastoidectomy.
Results:
Of the 19,920 unique children identified, 86.6% were in the younger age group with a mean age of 3.57 ± 1.59 years, and 61% were boys. At the end of follow-up, older children had statistically significantly higher TMP (6.9% versus 3.3%, p < 0.001), TT removal (5.1% versus 3.8%, p < 0.001), cholesteatoma (2.2% versus 0.8%, p < 0.001), and mastoidectomy (0.8% versus 0.3%, p < 0.001) rates when compared with younger children, respectively. Younger children experienced higher otorrhea rates when compared with older children (11% versus 6.4%, p < 0.001) but for a shorter period (324 ± 290 versus 404 ± 303 days, p < 0.001).
Conclusions:
Post-TTI complication rates are lower in the post-intervention era, except for cholesteatoma. This current quantitative appreciation of TTI complications can help both patients and caregivers define realistic postoperative expectations.
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