Abstract
PurposeAlthough common in children with tympanostomy tubes, the current incidence of tympanostomy tube otorrhea (TTO) is uncertain. TTO is generally a sign of otitis media, when middle ear fluid drains through the tube. Predictors for otitis media are therefore suggested to have predictive value for the occurrence of TTO.ObjectiveTo determine the incidence of TTO and its predictors.MethodsWe performed a cohort study, using a parental web-based questionnaire to retrospectively collect data on TTO episodes and its potential predictors from children younger than 10 years of age with tympanostomy tubes.ResultsOf the 1,184 children included in analyses (total duration of time since tube placement was 768 person years with a mean of 7.8 months per child), 616 children (52%) experienced one or more episodes of TTO. 137 children (12%) had TTO within the calendar month of tube placement. 597 (50%) children had one or more acute TTO episodes (duration <4 weeks) and 46 children (4%) one or more chronic TTO episodes (duration ≥4 weeks). 146 children (12%) experienced recurrent TTO episodes. Accounting for time since tube placement, 67% of children developed one or more TTO episodes in the year following tube placement. Young age, recurrent acute otitis media being the indication for tube placement, a recent history of recurrent upper respiratory tract infections and the presence of older siblings were independently associated with the future occurrence of TTO, and can therefore be seen as predictors for TTO.ConclusionsOur survey confirms that otorrhea is a common sequela in children with tympanostomy tubes, which occurrence can be predicted by age, medical history and presence of older siblings.
Highlights
Tympanostomy tube placement is one of the most common surgical procedures performed in children worldwide, with around 50,000 children in the Netherlands, and almost 700,000 in the United States receiving tubes each year. [1,2] Indications for tympanostomy tubes include prevention of acute otitis media (AOM) recurrences in children with recurrent AOM and restoration of hearing in children with persistent otitis media with effusion (OME). [3] Tympanostomy tube otorrhea (TTO) is a well-known and common sequela in children with tympanostomy tubes
Of the 1,184 children included in analyses, 616 children (52%) experienced one or more episodes of TTO. 137 children (12%) had TTO within the calendar month of tube placement. 597 (50%) children had one or more acute TTO episodes and 46 children (4%) one or more chronic TTO episodes. 146 children (12%) experienced recurrent TTO episodes
Recurrent acute otitis media being the indication for tube placement, a recent history of recurrent upper respiratory tract infections and the presence of older siblings were independently associated with the future occurrence of TTO, and can be seen as predictors for TTO
Summary
Tympanostomy tube placement is one of the most common surgical procedures performed in children worldwide, with around 50,000 children in the Netherlands, and almost 700,000 in the United States receiving tubes each year. [1,2] Indications for tympanostomy tubes include prevention of acute otitis media (AOM) recurrences in children with recurrent AOM and restoration of hearing in children with persistent otitis media with effusion (OME). [3] Tympanostomy tube otorrhea (TTO) is a well-known and common sequela in children with tympanostomy tubes. [3] Tympanostomy tube otorrhea (TTO) is a well-known and common sequela in children with tympanostomy tubes. It is generally a sign of otitis media (OM), when middle ear fluid drains through the tube. As parents generally hope that tympanostomy tubes will solve their child’s middle ear problems, they may be disappointed, or anxious, when their child develops TTO. [6] A subsequent trial reported a TTO incidence of 75% at 12 months after tube placement in children younger than 3 years. [7] Irrespective of the wide range of reported incidences, changes in health care practice over the last decade, such as development of new OM guidelines and the introduction of pneumococcal vaccination in children, may have changed the incidence of TTO A metaanalysis reported an average TTO incidence of 26% based on 23 studies with incidences ranging from 4% up to 68%. [6] A subsequent trial reported a TTO incidence of 75% at 12 months after tube placement in children younger than 3 years. [7] Irrespective of the wide range of reported incidences, changes in health care practice over the last decade, such as development of new OM guidelines and the introduction of pneumococcal vaccination in children, may have changed the incidence of TTO
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