Post-tympanostomy Tube Otorrhea Research Articles

Tympanostomy Tube Otorrhea: Microbiological Differences Between Children with and Without Cleft Palate.

To characterize and compare microbiological profiles in tympanostomy tube otorrhea for children with and without cleft palate. Retrospective cohort study. Pediatric otolaryngology and multidisciplinary cleft/craniofacial clinic at a single tertiary care center. Children with and without cleft palate <18 years of age who underwent tympanostomy tube placement between 2017-2021. Otopathogen profiles and antibiotic resistance patterns in ear culture specimens obtained in children presenting for treatment of recalcitrant post-tympanostomy tube otorrhea. Of the 886 children with tympanostomy tubes placed between 2017-2021, 345 (38.9%) had clinically significant otorrhea defined as requiring at least one otolaryngology visit for treatment. Children with cleft palate had higher rates of otorrhea (50.0% versus 35.7%; P < .01). In the 128 cultures obtained, Staphylococcus aureus was the most common organism in both groups present in 39.8% of cultures; 49% were methicillin-resistant (MRSA). Pseudomonas aeruginosa was also frequently isolated (20.0% versus 23.4%, P = .69) in children with and without cleft palate. Collectively, fluoroquinolone resistance was observed in 68.6% and 27.6% of the S. aureus and P. aeruginosa isolates, respectively, however, no differences in fluoroquinolone resistance were observed between cleft and non-cleft cohorts. Corynebacterium species were isolated more frequently in children with cleft palate (26.7% versus 6.1%, P < .01), a finding of unclear significance. Recalcitrant post-tympanostomy tube otorrhea is more common in children with cleft palate. MRSA was the most common isolate, which was commonly resistant to first-line fluoroquinolone therapy.

Inhibitory Effect of Thymol on Tympanostomy Tube Biofilms of Methicillin-Resistant Staphylococcus aureus and Ciprofloxacin-Resistant Pseudomonas aeruginosa.

The formation of antibiotic-resistant strain biofilms in tympanostomy tubes results in persistent and refractory otorrhea. In the present study, we investigated the in vitro antibiofilm activity of thymol against biofilms formed by methicillin-resistant Staphylococcus aureus (MRSA) and ciprofloxacin-resistant Pseudomonas aeruginosa (CRPA), using live and dead bacterial staining and adhesion, biofilm formation, biofilm eradication, and biofilm hydrolytic activity assays. The antibiofilm activity of thymol against tympanostomy tube biofilms formed by MRSA and CRPA strains was examined using a scanning electron microscope. In response to thymol treatment, we detected significant concentration-dependent reductions in the viability and adhesion of MRSA and CRPA. Exposure to thymol also inhibited the formation of both MRSA and CRPA biofilms. Furthermore, thymol was observed to enhance the eradication of preformed mature biofilms produced by MRSA and CRPA and also promoted a reduction in the rates of MRSA and CRPA hydrolysis. Exposure to thymol eradicated extracellular polysaccharide present in the biofilm matrix produced by MRSA and CRPA. Additionally, thymol was observed to significantly eradicate MRSA and CRPA biofilms that had formed on the surface on tympanostomy tubes. Collectively, our findings indicate that thymol is an effective inhibitor of MRSA and CRPA biofilms, and accordingly has potential utility as a therapeutic agent for the treatment of biofilm-associated refractory post-tympanostomy tube otorrhea resulting from MRSA and CRPA infection.

Humanized Anti-DNABII Fab Fragments Plus Ofloxacin Eradicated Biofilms in Experimental Otitis Media.

To evaluate the ability of humanized monoclonal antibody fragments directed against a bacterial DNABII protein plus ofloxacin delivered directly into the chinchilla middle ear via tympanostomy tube (TT) to enhance the ability of ofloxacin to eradicate biofilms formed by nontypeable Haemophilus influenzae (NTHI). A blinded pre-clinical study of comparative efficacy of single versus combinatorial treatment strategies. NTHI was allowed to form biofilms in the middle ears of chinchillas prior to TT placement. Ofloxacin, humanized Fab fragments against a bacterial DNABII protein that disrupts biofilms or Fab fragments plus ofloxacin were instilled into the middle ear via TT. For two consecutive days, ofloxacin was delivered twice-a-day, Fab fragments were delivered once-a-day, or these treatments were combined. Relative biofilm resolution (as determined via two outcome measures) and eradication of viable NTHI were assessed 1-day later. Whereas ofloxacin alone did not resolve biofilms or eradicate NTHI from the middle ear, delivery of Fab fragments significantly reduced both biofilms and NTHI burden over this short course of treatment. Notably, co-delivery of ofloxacin plus humanized Fab fragments eradicated both NTHI and biofilms from the middle ear, an enhanced outcome compared to receipt of either treatment alone. This study demonstrated a powerful combinatorial approach to release bacteria from their protective biofilms and rapidly render them vulnerable to killing by a previously ineffective antibiotic. An approach to combine ofloxacin with humanized Fab fragments that disrupt biofilms has tremendous potential to quickly resolve chronic otorrhea suffered by children with chronic suppurative otitis media or chronic post-tympanostomy tube otorrhea and thereby improve their quality of life. NA Laryngoscope, 131:E2698-E2704, 2021.

Role of Biofilms in Post-Tympanostomy Tube Otorrhea.

Nearly half of children who undergo tympanostomy tube (TT) insertion may experience otorrhea following surgery. We sought to review the evidence for the role of bacterial biofilms in post-tympanostomy tube otorrhea (PTTO) and the accumulated experience regarding the preventive measures for biofilm formation/adhesion on TTs. English literature search for relevant MeSH keywords was conducted in the following databases: MEDLINE (via PubMed), Ovid Medline, Google Scholar, and Clinical Evidence (BMJ Publishing) between January 1, 1995, and December 31, 2019. Subsequently, articles were reviewed and included if biofilm was evident in PTTO. There is an increased evidence supporting the role of biofilms in PTTO. Studies on TT design and material suggest that nitinol and/or silicone TTs had a lower risk for PTTO and that biofilms appeared in specific areas, such as the perpendicular junction of the T-tubes and the round rims of the Paparella-type tubes. Biofilm-component DNAB-II protein family was present in half of children with PTTO, and targeting this protein may lead to biofilm collapse and serve as a potential strategy for PTTO treatment. Novel approaches for the prevention of biofilm-associated PTTO include changing the inherent tube composition; tube coating with antibiotics, polymers, plant extracts, or other biofilm-resistant materials; impregnation with antimicrobial compounds; and surface alterations by ion-bombardment or surface ionization, which are still under laboratory investigation. Currently, there is no type of TT on which bacteria will not adhere. The challenges of treating PTTO indicate the need for further research in optimization of TT design, composition, and coating.

In vitro inhibitory activity of N-acetylcysteine on tympanostomy tube biofilms from methicillin-resistant Staphylococcus aureus and quinolone-resistant Pseudomonas aeruginosa

ObjectivesBiofilm formation in tympanostomy tubes causes persistent and refractory otorrhea. In the present study, we investigated the in vitro antibiofilm activity of N-acetylcysteine (NAC) against biofilm formation by methicillin-resistant Staphylococcus aureus (MRSA) and quinolone-resistant Pseudomonas aeruginosa (QRPA). MethodsWe examined the antibiofilm activity of NAC against biofilms produced by MRSA and QRPA strains using in vitro biofilm formation assay, adhesion assay, and biofilm eradication assay. Additionally, the antibiofilm activity of different concentrations of NAC against tympanostomy-tube biofilms from MRSA and QRPA strains was compared using a scanning electron microscope. ResultsThe adhesion of MRSA and QRPA strains decreased significantly in a concentration-dependent manner after treatment with varying amounts of NAC. Treatment with NAC inhibited biofilm formation of both MRSA and QRPA strains and increased eradication of preformed mature biofilm produced by MRSA and QRPA. Besides, NAC exhibited significant eradication-activity against tympanostomy-tube biofilms produced by MRSA and QRPA strains. ConclusionsOur results show potent inhibition of MRSA and QRPA biofilm after treatment with NAC. NAC shows potential for the treatment of biofilms and refractory post-tympanostomy tube otorrhea resulting from MRSA and QRPA infection.

A newly designed tympanostomy stent with TiO2 coating to reduce Pseudomonas aeruginosa biofilm formation

Biofilm formation has been implicated as a cause of post-tympanostomy tube otorrhea in patients suffering from otitis media with effusion, and biofilms have been found to adhere to all available types of tympanostomy tubes (TT) made from silicone. In this study, we present a novel stent designed with a reduced surface area and a titanium dioxide (TiO2) coating to prevent biofilm formation. Using a radio frequency power supply, tympanostomy stents (TS) made from Nitinol (Nikel-titanium) were coated with TiO2 to form an oxide layer on the metallic target. We successfully reproduced biofilms with carbenicillin-resistant Pseudomonas aeruginosa strain, PAO1-GFP (green fluorescent protein) on the tubes in vitro. We then compared the levels of biofilm formation by this strain on the two types of implants using several methods, including bacterial quantification, electron microscopy, and confocal laser fluorescent microscopy. Our results provide definitive evidence that the combination of the TiO2 coating and minimized surface area of the Nitinol stent inhibited the P. aeruginosa biofilm formation. The ability of the TS to prevent viable bacteria colonization (over 10 folds, compared to silicone TT) was verified by anti-biofilm test. Future studies will reveal more useful in reducing otorrhea and plugging complications as a novel tympanostomy tube.

Prospective observational case series evaluating middle ear fluid and tympanostomy tubes through pyrosequencing

ObjectiveOne of the most common sequelae of tympanostomy tube (TT) placement is post-tympanostomy tube otorrhea (PTTO). Granulation tissue formation has been reported in 5–13.8% of patients with TT placement. The purpose of this study is to determine the biodistribution of microorganisms on TTs and middle ear fluid obtained from patients with PTTO. MethodsThis was a prospective observational study of subjects (6-months–16-years) who underwent standard of care treatment for chronic PTTO. Data was collected on diagnosis, existence of antibiotic resistance, duration of tube placement, and evidence of recurrent infection and/or PTTO. TTs and middle ear fluid were subjected to pyrosequencing; additionally, ear fluid samples were sent for culture-based laboratory diagnostics. ResultsDNA-pyrosequencing analysis of bacteria from fluid and TTs of pediatric subjects with PTTO revealed a mixture of both aerobic and anaerobic populations. Retained tubes with minimal otorrhea revealed a predominance of Staphylococcus species, normal external auditory canal (EAC) microbiome, within middle ear fluid as well as on TTs. However, TTs with active mucopurulent otorrhea and granulation tissue unveiled prominence of Gram-negative facultative anaerobes such as Pseudomonas and Eikenella. Discrepancies in prominent bacteria were seen between standard culture-based techniques versus pyrosequencing. ConclusionRetained tympanostomy tubes are colonized primarily with normal flora of the EAC. However, mucopurulent otorrhea associated with granulation tissue formation revealed a prominence of Gram-negative facultative anaerobes. Standard culture-based diagnostics may identify bacteria, which are not predominant species of infection. Future studies are necessary to assess the association of Gram-negative facultative anaerobes with granulation tissue formation.

Planktonic Growth of Pseudomonas aeruginosa around a Dual-Species Biofilm Supports the Growth of Fusobacterium nucleatum within That Biofilm.

Purpose The goal of this study was to understand the potential interaction between Pseudomonas aeruginosa and Fusobacterium nucleatum within the middle ear. MethodsWe examined the microbiota of ear fluid and tympanostomy tubes (TTs) obtained from patients with posttympanostomy tube otorrhea. We also examined biofilms formed by P. aeruginosa and F. nucleatum, singly or together, under aerobic or anaerobic conditions. Results While the facultative anaerobe P. aeruginosa dominated the bacterial population within the ear fluid, strict anaerobes, including F. nucleatum, dominated bacterial populations within the TTs. F. nucleatum was able to grow under aerobic conditions only in the presence of P. aeruginosa, whose growth reduced the level of dissolved oxygen within the broth to nearly anoxic condition within 4 h after inoculation. The presence of P. aeruginosa allowed F. nucleatum to maintain its growth for 72 h within the dual-species biofilm but not within the planktonic growth. Visualization of the biofilms revealed coaggregation of P. aeruginosa and F. nucleatum. Conclusion Extrapolation of these results suggests that, within the middle ear fluid, the growth of P. aeruginosa produces the anaerobic conditions required for the growth of F. nucleatum, both within effusion and within biofilms.

The impact of tobacco exposure on development of otorrhea after myringotomy tube placement

IntroductionOtorrhea is a common sequela after myringotomy with tube placement (MTP). The purpose of this study was to identify any significant relationship between passive tobacco exposure and the development of post-tympanostomy tube otorrhea. MethodsRetrospective chart review was performed on 774 cases of patients who underwent MTP by a single surgeon at a tertiary pediatric hospital from 2012 to 2014. Patients with multiple medical comorbidities, craniofacial anomalies, syndromes and those over 12 years of age were excluded. Multivariate logistic regression analysis was performed to determine if there was a relationship between risk factors (including tobacco exposure, age, pre-operative diagnosis, operative findings and duration of follow-up) and the development of post-tympanostomy tube otorrhea. ResultsOne hundred and ninety-one patients (average age of 1.92 years) were included. Overall, 16.8% of patients (32/191) had exposure to tobacco smoke. Of patients with passive smoke exposure, 65.6% (21/32) developed otorrhea, as compared to 45.3% (72/159) of those without tobacco exposure. Passive exposure to tobacco smoke by (OR = 2.307; p = 0.009; 95% CI, 1.734–6.028) and younger age (p = 0.012; 95% CI, 0.602–0.938) were associated with increased risk for otorrhea. DiscussionThis study suggests that in a cohort of patients undergoing MTP, passive exposure to tobacco smoke significantly increases the risk of developing post-operative otorrhea. This information is valuable to include in parental preoperative counseling regarding tympanostomy tube placement.

Identification of biofilms in post-tympanostomy tube otorrhea.

Otitis media is a common problem in the pediatric population. Despite antibiotic therapy, post-tympanostomy otorrhea can be difficult to treat. Biofilms have been shown to play a role in chronic and recurrent otitis media and are implicated in otorrhea. This study investigated both the microbial composition and the presence of biofilm fragments rich in extracellular DNA (eDNA) and the bacterial DNA-binding protein, integration host factor (IHF), in post-tympanostomy tube otorrhea. Clinical samples. Institutional review board approval was obtained, and samples were recovered from pediatric patients with tympanostomy tubes and persistent otorrhea for both microbial culture and biofilm analysis. For biofilm assessment, frozen samples were sectioned and then labeled using a rabbit anti-IHF, which was detected with goat anti-rabbit IgG conjugated to AlexaFluor 594. Samples were then counterstained with 4',6-diamidino-2-phenylindole (DAPI) to detect DNA, and images were captured by inverted light microscopy. Of 15 pediatric otorrhea samples analyzed, nine (60%) contained solids that were positive for labeling of IHF in association with a lattice of eDNA, and 75% yielded positive bacterial cultures. Bacterial culture results included H. influenzae, Methicillin-resistant Staphylococcus aureus, S. pneumoniae, M. catarrhalis, and P. aeruginosa. Positive labeling of otorrhea solids for eDNA and IHF, in combination with microbiological culture results, indicated that biofilms likely played a key role in chronic otorrhea. Moreover, as a known critical structural component of biofilms, these findings suggest that DNABII proteins in association with eDNA may serve as an important therapeutic target in post-tympanostomy tube otorrhea. NA. Laryngoscope, 126:1946-1951, 2016.

Can curcumin prevent the formation of Pseudomonas aeruginosa biofi lm on the surface of tympanostomy tubes?

Formation of bacterial biofilm on the surface of tympanostomy tubes are held responsible in the pathogenesis of post-tympanostomy tube otorrhea. To prevent the formation of biofilm, various methods were employed and varying degrees of success have been achieved. In some recent studies curcumin, which is the fenolic form of Curcuma longa (turmeric), has been pointed out to have inhibitory effects on virulence factors of Pseudomonas aeruginosa. The aim of this study was to investigate whether the administration of curcumin is able to prevent the formation of P.aeruginosa biofilm on the surface of silicone tympanostomy tubes in vitro conditions. For this purpose, qualitative and quantitative analysis of P.aeruginosa biofilm created on the surface of the tympanostomy tubes were performed following a period of 48 hours incubation in microplate wells that contained decreasing concentrations of curcumin. For qualitative analysis, specimens were evaluated with an environmental scanning electron microscope for the existence of biofilm. For the quantitative analysis, bacteria attached to the tube surface was detached using a combination of vortexing and sonication. Following serial dilutions, the obtained solution was then inoculated on the sheep blood agar plates using calibrated loop, incubated for 24 hours and the colony forming unit (CFU) per mL were recorded. Environmental scanning electron microscope analysis revealed that 100 µg/mL of curcumin could prevent formation of the biofilm. Lower concentrations of curcumin could not prevent the biofilm formation. Qualitative analysis also revealed that when the concentrations of curcumin in the wells were decreased, the number of CFU/mL was increased significantly. Mean number of CFU in 100 µg/mL and 12.5 µg/mL groups were 35±7.07 and 650±494, respectively. Curcumin could prevent formation of P.aeruginosa biofilm on the surface of tympanostomy tubes in vitro with concentrations lower than the MIC value. The results of the present study show that local administration of curcumin may prevent suppurative otitis media following tympanostomy tube insertion, keep the patency of the tube and decrease the rate of treatment failure. In vivo studies are needed to support the in vitro anti-biofilm action of curcumin on tympanostomy tubes.

The rationale for preventive treatments for early post-tympanostomy tube otorrhea in persistent otitis media with effusion.

Some studies have shown that post-tympanostomy tube otorrhea (PTTO) is a common complication after tympanostomy tube insertion. There are wide range of controversies about the incidence of PTTO and different methods of preventive treatment. The aim of this study was to determine the incidence of early PTTO in persistent otitis media with effusion in our centers. We also investigated the effect of preventive treatments on the incidence of early PTTO in children with persistent otitis media with effusion. This multi-central study comprised 536 ears belonging to children with otitis media and effusion for at least 3 months, referred for complications arising from post-tympanostomy tube insertion. The patients were randomly divided into three treatment and control groups. In the first group of patients, the middle ear cavity was irrigated with isotonic saline after myringotomy. The second group received oral amoxicillin three times a day for 7days postoperatively. The third group had similar treatment as the second group, in addition to topical ciprofloxacin drop, 4 drops three times a day for 3days after operation. The control group did not undergo any treatment. Early post-tympanostomy tube otorrhea was detected in 6 ears (1.1%), including 3 (2.2%) from the control group and 3 (2.3%) from the first group. There was no statistically significant difference in early PTTO between integrated treatment groups and control group (P=0.111). As the total rate of early post-tympanostomy tube otorrhea was very low, there was no significant difference between the 3 treatment groups and control group. Our study did not support the routine use of preventive therapy. A period of at least 3months watchful waiting before tympanostomy tube insertion may help reduce the incidence of PTTO.

Biofilm formation on tympanostomy tubes depends on methicillin-resistant Staphylococcus aureus genetic lineage.

Bacterial biofilm formation has been implicated in the high incidence of persistent otorrhoea after tympanostomy tube insertion. The aim of the study was to investigate whether biofilm formation on tympanostomy tubes depends on the genetic profile of methicillin-resistant Staphylococcus aureus (MRSA) strains. Capacity of biofilm formation on fluoroplastic tympanostomy tubes (TTs) was tested on 30 MRSA strains. Identification and methicillin resistance were confirmed by PCR for nuc and mecA genes. Strains were genotypically characterised (SCCmec, agr and spa typing). Biofilm formation was tested in microtiter plate and on TTs. Tested MRSA strains were classified into SCCmec type I (36.7 %), III (23.3 %), IV (26.7 %) and V (13.3 %), agr type I (50 %), II (36.7 %) and III (13.3 %), and 5 clonal complexes (CCs). All tested MRSA strains showed ability to form biofilm on microtiter plate. Capacity of biofilm formation on TTs was as following: 13.3 % of strains belonged to the category of no biofilm producers, 50 % to the category of weak biofilm producers and 36.7 % to moderate biofilm producers. There was a statistically significant difference between CC, SCCmec and agr types and the category of biofilm production on TTs tubes (p < 0.001): CC5, SCCmecI type and agrII type with a moderate amount of biofilm, and CC8 and agrI type with a low amount of biofilm. Biofilm formation by MRSA on TTs is highly dependent on genetic characteristics of the strains. Therefore, MRSA genotyping may aid the determination of the possibility of biofilm-related post-tympanostomy tube otorrhea.

Does Tube Type Matter in Posttympanostomy Tube Otorrhea?

Objectives: The objective of this study was to review consecutive tympanostomy tube surgeries for the past 8 years, paying particular attention to the type of tube inserted at the time of surgery. Methods: Retrospective chart analysis of the last 3046 consecutive ears for tympanostomy tube surgery from 2005 to 2013. Results: Out of 3046 total ears reviewed, the total rate of otorrhea was 3.78% with 0.0% otorrhea in titanium tubes, 0.0% otorrhea in Sheehy activent tubes, 2.19% otorrhea in Donaldson tubes, 2.72% otorrhea in Sheehy collar button tubes, 3.28% otorrhea in Shepard tubes, 3.88% otorrhea in fluoroplastic tubes, 6.9% otorrhea in stainless steel tubes, 18.52% otorrhea in Goode tubes, and 25.0% otorrhea in triune tubes. Conclusions: Early posttympanostomy tube otorrhea is a frequent complication of tympanostomy tube insertion with a complication rate of 3.8%, and the type of tubes placed at time of surgery seems to make a difference in the incidence of posttympanostomy otorrhea.

Strategies to prevent biofilm-based tympanostomy tube infections

ObjectiveTo review the potential contributory role of biofilms to post-tympanstomy tube otorrhea and plugging as well as the available interventions currently utilized to prevent biofilm formation on tympanostomy tubes. Data sourcesA literature review was performed utilizing the MEDLINE/Pubmed database from 1980 to 2013. Review methodsElectronic database was searched with combinations of keywords “biofilm”, “tympanostomy tube”, “ventilation tube”, and “post-tympanostomy tube otorrhea”. ResultsTwo of the most common sequelae that occur after tympanostomy tube insertion are otorrhea and tube occlusion. There is an increased evidence supporting a role for biofilms in the pathogenesis of otitis media. In this review, we have shown a multitude of novel approaches for prevention of biofilm associated sequelae of otitis media with effusion. These interventions include (i) changing the inherent composition of the tube itself, (ii) coating the tubes with antibiotics, polymers, plant extracts, or other biofilm-resistant materials, (iii) tubal impregnation with antimicrobial compounds, and (iv) surface alterations of the tube by ion-bombardment or surface ionization. ConclusionCurrently, there is not one type of tympanostomy tube in which bacteria will not adhere. The challenges of treating chronic post-tympanostomy tube otorrhea and tube occlusion indicate the need for further research in optimization of tympanostomy tube design in addition to development of novel therapies.

Inhibition of Otopathogenic Biofilms by Organoselenium-Coated Tympanostomy Tubes

Tube occlusion and post-tympanostomy tube otorrhea (PTTO) are 2 major sequelae of tympanostomy tube placement. Plugging negates the function of the tympanostomy tubes and, along with chronic PTTO, can be financially burdensome owing to repeated surgical procedures and additional treatments. To investigate the effectiveness of an organoselenium (OSe) coating on Donaldson tympanostomy tubes in inhibiting biofilm formation on the tympanostomy tubes. In vitro microbiologic study; all experiments were performed in a Texas Tech University Health Sciences Center basic sciences laboratory. Inhibition of biofilm formation was investigated by incubating OSe-coated vs uncoated (control) tympanostomy tubes in a nutrient broth containing either Staphylococcus aureus (Sa) expressing green fluorescent protein (GFP), nontypeable Haemophilus influenzae (NTHi) expressing GFP, or Moraxella catarrhalis (Mc) for 48 hours at 37 °C. All biofilms were quantified via colony-forming unit (CFU) assays. The Sa and NTHi biofilms were visualized using confocal laser-scanning microscopy (CLSM) and analyzed using the COMSTAT program. The CFU assays, CLSM, and COMSTAT analysis revealed that compared with uncoated control tympanostomy tubes, OSe-coated tympanostomy tubes are able to inhibit Sa, NTHi, and Mc biofilm formation. The Sa and NTHi developed thick mature biofilms containing considerable biomass on uncoated tympanostomy tubes as determined by CLSM and COMSTAT analysis, while the OSe coating on the tympanostomy tubes drastically inhibited biofilm formation by Sa and NTHi. Quantitative CFU analysis revealed that this reduction in biofilm formation was significant, 6 logs for Sa (P < .001) and 4 logs for NTHi (P = .02). OSe coating also inhibited biofilm formation by Mc with a 4.5-log reduction (P < .001). The OSe coating is a potential long-lasting agent to prevent biofilm development on tympanostomy tubes by otopathogens.

Najczęstsze powikłania pooperacyjne w otolaryngologii w pediatrycznym szpitalnym oddziale ratunkowym

Postoperative complications in pediatric otolaryngology often present to the emergency department. Posttonsillectomy hemorrhage is a feared complication due to its lethal potential and should be managed in conjunction with an otolaryngologist. Physicians should possess and awareness of procedures that have been used in an emergent setting. Postoperative pain management options are discussed including acetaminophen, acetaminophen with codeine, and nonsteroidal anti-inflammatory drugs. Rare postadenoidectomy complications such as nasopharyngeal stenosis and Grisel syndrome are discussed. Tympanostomy tubes are the most common surgery in children, and the proper treatment of posttympanostomy tube otorrhea is discussed.

Draining Ears and Tympanostomy Tubes

Posttympanostomy tube otorrhea also known as acute otitis media with tympanostomy tubes (AOMT) occurs in 15% to 80% of children with tympanostomy tubes. Its management is fairly standardized among pediatric ear, nose, and throat (ENT) physicians owing to recommendations published by the American Academy of Otolaryngology-Head and Neck Surgery. Pediatric emergency medicine (EM) physicians have no such guidelines. This study aimed to compare management of AOMT by pediatric ENT and EM physicians. A 27-question online survey was disseminated via SurveyMonkey.com using e-mail addresses of ENT and EM physicians via organization directories and professional listserves. A total of 175 and 174 responses were received from EM and ENT physicians, respectively. Higher proportion of EM physicians used oral antibiotics to treat AOMT (54% [n = 94] vs 9% [n = 16], P < 0.001). Virtually all ENT physicians used topical antibiotics, compared with 87% of EM physicians. Only 6% (n = 10) of EM physicians used suction to clean ear canals (aural toilet) before instilling topical antibiotics, compared with 81% (n = 138) of ENT physicians. Most ENT physicians (80% [n = 138]) instructed patients to keep the treated ear up for 10 to 60 seconds after instilling the drops and to use the tragal pump technique to direct the medication down the ear canal and through the tube (92% [n = 157]). Only 56% (n = 98) and 24% (n = 41) of EM physicians did the same. There are large differences between ENT and EM physicians with respect to: the use of systemic antibiotics, techniques of using ototopical antibiotics, methods of aural toilet in treating AOMT, and directions given to patients.

Recurrent Post-Tympanostomy Tube Otorrhea Secondary to Aerobic Endospore-Forming Bacilli: A Case Report and Brief Literature Review

We report a unique case in which a 57-year-old man with an 8-year history of late recurrent post-tympanostomy tube otorrhea (PTTO) was found to harbor Bacillus subtilis, an aerobic endospore-forming bacillus that is typically resistant to chemical and physical agents because of its unique life cycle. Removal of the patient's tympanostomy tube resulted in complete resolution of his long-standing otorrhea. We also review the etiologies of and treatment strategies for early, late, chronic, and recurrent PTTO. We conclude that regardless of the etiology, a patient with persistent or recurrent PTTO should consider undergoing removal of the ventilation tube.

Tympanostomy Tube In Vitro Biofilm Potential of Common Otopathogens

Post-tympanostomy tube otorrhea has been linked to microbial biofilms. The purpose of this study was to compare the tympanostomy tube-biofilm-forming propensity of common otopathogens Pseudomonas aeruginosa, Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae. Controlled, in vitro. Academic research laboratory. Fluoroplastic coupons (1656 total, 46 per treatment per incubation period) were exposed to plasma and cultured with 3 strains each of the bacterial species for 2, 4, or 7 days. Half of the coupons were treated with antibiotics to kill planktonic bacteria. Total and biofilm colony counts and electron microscopy were performed. S aureus formed biofilm after 2 days, not different from 4- or 7-day biofilms (P > .05), and was most tolerant to antibiotic treatment. P aeruginosa also formed biofilms at 2 days, reached a plateau at 4 days (P > .05), and decreased at 7 days (P < .01). H influenzae formed biofilm only after 4 days (P ≤ .04). S pneumoniae did not form biofilm without catalase supplementation. With catalase, 1 S pneumoniae strain showed a delay in biofilm formation similar to H influenzae (P < .0001), while the other 2 strains formed biofilms after 2 days. Tympanostomy tube biofilm formation occurs with common middle ear pathogens but most readily with S aureus and P aeruginosa. Further investigation is needed to determine if these findings may, in part, explain the occasionally refractory nature of post-tympanostomy tube otorrhea associated with S aureus and P aeruginosa.