The limits of pandemic precautions: Tympanostomy tube placement in children with cleft palate during COVID-19

Eustachian tube dysfunction is a nearly universal complication of cleft palate, resulting in chronic ear disease and conductive hearing loss. Cleft palate repair is thought to result in recovery of eustachian tube function, but the length of time between repair and recovery of eustachian tube function is not known. Furthermore, the efficacy of tympanostomy tubes in the treatment of eustachian tube dysfunction and hearing sequelae has not been examined in a systematic way. To answer these questions, we performed a retrospective study that used serial audiometric data and tympanometry on 81 patients with cleft palates (162 ears), with follow-up ranging from 1 to 17.3 years. Average time to recovery of eustachian tube function was 6.0 years (range, 1.0 to 10.3 years) after cleft palate surgery. For children followed up for at least 6 years (longest follow-up, 17.3 years), 70% (67 of 85) had normal eustachian tube function at their last follow-up visit. Ears treated with Armstrong tympanostomy tubes required an average of 3.1 tubes per ear until recovery of eustachian tube function, whereas ears treated with Goode T tubes required only 1.1 tubes per ear ( p < 0.05). Hearing evaluation revealed that 67% of ears had abnormal hearing thresholds (>20 dB) before tympanostomy tube placement, whereas only 7.5% of ears demonstrated this loss after tube placement. Furthermore more than 90% of ears maintained normal thresholds after recovery of eustachian tube function. These data indicate that most children with cleft palates eventually recover normal eustachian tube function after palatoplasty, but for the majority of children, this does not occur for many years. Furthermore, the hearing loss before tympanostomy tube placement and palatoplasty largely resolves after aeration of the middle ear and does not result in any significant permanent hearing deficit.

Download Full-text

Are water precautions necessary after tympanostomy tube placement? A cadaver study

International Journal of Pediatric Otorhinolaryngology ◽

10.1016/j.ijporl.2021.110632 ◽

2021 ◽

Vol 143 ◽

pp. 110632

Author(s):

Anthony Sanchez ◽

Gabriel Arom ◽

Hector A. Perez ◽

Laura Royal ◽

TJ O-Lee

Keyword(s):

Cadaver Study ◽

Tube Placement ◽

Tympanostomy Tube

Download Full-text

Helping Children with Special Needs: Who Receives Tympanostomy Tubes?

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420987425 ◽

2021 ◽

pp. 000348942098742

Author(s):

David W. Wassef ◽

Nehal Dhaduk ◽

Savannah C. Roy ◽

Gregory L. Barinsky ◽

Evelyne Kalyoussef

Keyword(s):

Developmental Disorders ◽

Developmental Disorder ◽

Private Insurance ◽

Insurance Coverage ◽

Tube Placement ◽

Hospital Charges ◽

Tympanostomy Tube ◽

Tube Insertion ◽

Tympanostomy Tubes

Objectives: Tympanostomy tubes can prevent sequelae of otitis media that adversely affect long term hearing and language development in children. These negative outcomes compound the existing difficulties faced by children who are already diagnosed with developmental disorders. This study aims to characterize this subset of children with developmental disorders undergoing myringotomy and tympanostomy tube insertion. Methods: A retrospective review using the Kids’ Inpatient Database (KID) was conducted, with codes from International Classification of Diseases, Ninth Revision used to query data from the years 2003 to 2012 to determine a study group of children with a diagnosis of a developmental disorder undergoing myringotomy and tympanostomy insertion. This group was compared statistically to patients undergoing these procedures who did not have a diagnosed developmental disorder. Results: In total, 21 945 cases of patients with myringotomy with or without tympanostomy tube insertion were identified, of which 1200 (5.5%) had a diagnosis of a developmental disorder. Children with developmental disorders had a higher mean age (3.3 years vs 2.9 years, P = .002) and higher mean hospital charges ($43 704.77 vs $32 764.22, P = .003). This cohort also had higher proportions of black (17.6% vs 12.3%, P < .001) and Hispanic (23.9% vs 20.6%, P = .014) patients, and had lower rates of private insurance coverage (39.6% vs 49%, P < .001). Conclusion: The population of children with developmental disorders undergoing myringotomy or tympanostomy tube placement has a different demographic composition than the general population and faces distinct financial and insurance coverage burdens. Further study should be done to assess if these differences impact long term outcomes.

Download Full-text

The Effect of the COVID-19 Pandemic on Pediatric Tympanostomy Tube Placement

Otolaryngology ◽

10.1177/01945998211008916 ◽

2021 ◽

pp. 019459982110089

Author(s):

Gillian R. Diercks ◽

Michael S. Cohen

Keyword(s):

Tertiary Care ◽

Chronic Otitis Media ◽

Community Setting ◽

Tube Placement ◽

Tympanostomy Tube ◽

Care Providers ◽

Billing Data ◽

Patient Age ◽

Patient Âgé ◽

Tympanostomy Tubes

Objective To evaluate how the coronavirus disease 2019 (COVID-19) pandemic has affected tympanostomy tube placement and practice patterns. Study Design A retrospective review of billing data. Setting A large-volume practice with both community and tertiary care providers. Methods As part of a quality initiative, billing data were queried to identify children <18 years of age who underwent tympanostomy tube placement between January 2019 and December 2020. Patient age, practice location, and case numbers were gathered. Results The study included data from 2652 patients. Prior to state-mandated clinic and operating room restrictions, there were no significant differences in the number of tympanostomy tubes placed ( P = .64), including month-to-month comparisons, the distribution of patients being cared for at community vs tertiary care sites ( P = .63), or patient age at the time of surgery ( P = .97) between 2019 and 2020. After resumption of outpatient clinical and elective surgical activities, the number of tympanostomy tubes placed decreased significantly between 2019 and 2020 (831 vs 303 cases, P = .003), with a persistent month-to-month difference. In addition, patients undergoing tube placement were older (4.5 vs 3.2 years, P < .001). The distribution of cases performed in the community setting decreased during this time period as well ( P < .001). Conclusion During the COVID-19 pandemic, the rate of pediatric tympanostomy tube placement has significantly decreased. The age of patients undergoing surgery has increased, and more children are being cared for in a tertiary setting. These findings may reflect changes in the prevalence of acute and chronic otitis media as the result of the pandemic.

Download Full-text

Advanced Practice Provider Clinics: Expediting Care For Children Undergoing Tympanostomy Tube Placement

The Laryngoscope ◽

10.1002/lary.29477 ◽

2021 ◽

Author(s):

Michael A. Belsky ◽

Anisha Konanur ◽

Edward Sim ◽

Annie Yan ◽

Amber D. Shaffer ◽

...

Keyword(s):

Tube Placement ◽

Advanced Practice ◽

Tympanostomy Tube

Download Full-text

Shape-Memory Nitinol Tympanostomy Tube and All-in-One Introducer Device for Treatment of Otitis Media

Journal of Medical Devices ◽

10.1115/1.3443170 ◽

2010 ◽

Vol 4 (2) ◽

Author(s):

Michael Loushin ◽

Keith Leland

Keyword(s):

Shape Memory ◽

Otitis Media ◽

Point Of Care ◽

The United States ◽

Tube Placement ◽

Tympanostomy Tube ◽

Office Visits ◽

Antibiotic Resistant ◽

Bacterial Organism ◽

Disposable Device

Otitis media is the most common bacterial illness in children, resulting in millions of office visits, antibiotic prescriptions, and surgical procedures annually in the United States. Antibiotics are commonly prescribed and has resulted in increased prevalence of antibiotic resistant strains of organisms. Additionally, patients with otitis media are candidates for tympanocentesis, myringotomy, and tympanostomy tube placement procedures. The ability to safely and efficiently perform these procedures to accurately diagnose, identify the bacterial organism, and treat otitis media with point of care therapy is needed. A shape-memory nitinol tympanostomy tube and an all-in-one introducer device (OtoStent tympanostomy device) currently under development will allow clinicians to safely and efficiently perform myringotomy, tympanocentesis, and tympanostomy tube placement with a single disposable device.

Download Full-text