Tympanostomy Tube Sequelae Related to Pathogens

Abstract

Objective: Posttympanostomy tube (TT) sequelae have been associated with a wide range of middle ear pathogens. Though microbes commonly bind to TTs, it is unclear what leads to clinical pathology. The goal of our study was to investigate the role of middle ear pathogens in post-TT sequelae. Method: TTs were explanted for a range of indications and analyzed for biofilm formation using electron microscopy (EM) and quantitative polymerase chain reaction (qPCR) with specific primers for otopathogens. Results were correlated with the otologic status. Results: None of the 18 TTs demonstrated Aspergillus niger, Candida parapsilosis, or Candida albicans. Streptococcus pneumonia was found in one TT with recurrent otorrhea. Pseudomonas aeruginosa was found in 44.4% of TTs, 2 out of 2 TTs with active otorrhea, and 87.5% with recent or current otorrhea. Staphylococcus aureus was found in 78% of TTs and 6 out of 6 TTs with granulation tissue. Haemophilus influenza was found in 72% of TTs, irrespective of clinical status. EM revealed that TTs commonly have complex topographical features, which may serve as reservoirs for microbial growth and biofilm formation. Conclusion: Post-TT sequelae, such as otorrhea and granulation tissue, are more common with P aeruginosa and S aureus colonization and/or biofilm development. H influenza is also prevalent, but less clearly related to clinical pathology. These findings may have implications related to the pathogenesis and treatment of post-TT sequelae.