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Incidence of Recurrent Otitis Media With Effusion (OME) Following Tympanostomy in Pediatric Patients: A Systematic
Mohammad Hosein Taziki Balajelini1, Mohammad Reza Mofatteh2, Masoud Mohammadi3
1Department of Surgery, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran, goums.ac.ir.
Insights
Recurrent otitis media with effusion (OME) after tympanostomy tube extrusion affects about 30% of children globally. Incidence has declined since 2005, but recurrence is higher in children with cleft palate.
Area of Science:
- Pediatric Otolaryngology
- Epidemiology
- Evidence-Based Medicine
Background:
- Otitis media with effusion (OME) is a prevalent pediatric condition.
- Tympanostomy tube insertion is a common management strategy.
- Recurrence of OME post-tube extrusion is a significant clinical concern.
Purpose of the Study:
- To quantify the global incidence of recurrent OME following tympanostomy tube insertion.
- To analyze trends in OME recurrence over time.
- To identify risk factors associated with OME recurrence.
Main Methods:
- Systematic review and cumulative meta-analysis adhering to PRISMA guidelines.
- Comprehensive search of multiple electronic databases up to August 2024.
- Quality assessment using the Joanna Briggs Institute (JBI) tool and random-effects modeling for pooled incidence.
Main Results:
- Global pooled incidence of recurrent OME post-tympanostomy was 30% (95% CI: 23%-37%).
- Recurrence rates were 31% with tubes alone vs. 20% with adjunctive antibiotics.
- Highest recurrence (45%) observed in patients with cleft palate undergoing tympanostomy.
Conclusions:
- Approximately one-third of children experience recurrent OME after ventilation tube insertion.
- Adjunctive antibiotics may offer some benefit but require cautious interpretation.
- Patients with cleft palate have increased recurrence risk, necessitating long-term follow-up and further research.
Background:
Otitis media with effusion (OME) is a common pediatric condition, often managed with tympanostomy tube insertion. However, recurrence after tube extrusion remains a significant concern, with global incidence rates varying across studies.
Objective:
This systematic review and cumulative meta-analysis is aimed at quantifying the global incidence of recurrent OME post-tympanostomy.
Methods:
A systematic review and cumulative meta-analysis was conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive search of electronic databases (PubMed, Web of Science, Embase, Cochrane Library, ProQuest, Wiley, Ovid, and Scopus) was performed in August 2024. The quality of the studies was assessed using the Joanna Briggs Institute (JBI) critical assessment tool. Pooled incidence and 95% confidence intervals were calculated using a random-effects model. Cumulative meta-analyses were conducted to track global incidence trends over time. Statistical analysis was conducted using Stata Version 16 software.
Results:
From 1117 retrieved articles, 21 met the inclusion criteria. The global pooled incidence of recurrent OME post-tympanostomy was 30% (95% CI: 23%-37%). Subgroup analysis showed 31% recurrence with tubes alone (95% CI: 24%-38%) versus 20% with adjunctive antibiotics (95% CI: 14%-26%). The highest recurrence (45%, 95% CI: 34%-55%) occurred in cases combining tympanostomy with cleft palate surgery. Cumulative meta-analysis indicated a declining trend in OME recurrence between 2005 and 2019, with the incidence rate decreasing from 39% to 24% over this period.
Conclusions:
Approximately one-third of children undergoing ventilation tube (VT) insertion surgery experience recurrence of OME. Although some studies suggest that adding antibiotics to VT insertion therapy may reduce recurrence in children at risk for chronic infection, this evidence is not consistent and should be interpreted with caution. In addition, patients with cleft palate have a higher likelihood of OME recurrence and require long-term follow-up. These findings may assist physicians in refining treatment decisions based on individual patient characteristics and recurrence risk, though further high-quality clinical trials are needed to confirm these observations.
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