Helping Children with Special Needs: Who Receives Tympanostomy Tubes?

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.

scholarly journals Indications for tympanostomy tube insertion in children

New Medicine ◽  
2019 ◽  
Vol 23 (2) ◽  
Author(s):  
Maria Wolniewicz ◽  
Lidia Zawadzka-Głos
Keyword(s):  
Otitis Media ◽  
Otitis Media With Effusion ◽  
Tube Placement ◽  
Tympanostomy Tube ◽  
Negative Consequences ◽  
Tube Insertion ◽  
Tube Removal ◽  
Tympanostomy Tubes ◽  
Medical University ◽  
Recurrent Otitis Media

Introduction. Tympanostomy tube insertion is one of the basic paediatric otolaryngological procedures. Otitis media with effusion (OME) is the primary indication for elective qualification for this procedure. Currently, there are no recommendations suggesting pharmacotherapy for effusion. In cases of recurrent otitis media or acute complications of otitis media, tube insertion is a method of choice to support systemic antibiotic therapy. Aim. The main aim of this study was to evaluate indications for tympanostomy tube insertion. Secondary aims included characteristics of the study population and an intraoperative assessment of the tympanic membrane. Material and methods. We conducted a retrospective analysis of ear tube placement procedures performed in the Department of Paediatric Otorhinolaryngology of the Medical University of Warsaw between January 1, 2018 and December 31, 2018. Results. A total of 213 children (aged between 2 months and 18 years) underwent tympanostomy tube insertion and a total of 368 tubes were placed due to otitis media with effusion in 2018 in the Department of Paediatric Otorhinolaryngology of the Medical University of Warsaw. Elective tube insertion accounted for 69.48% of procedures. Recurrent otitis media (22.07%), complications of acute otitis media and, most of all, acute mastoiditis (23.33% of urgent procedures) came second. In a large majority of cases, Mikolow tympanostomy tubes were placed; in isolated cases, long-term tympanostomy tubes were used (14 T-tubes, 7 Paparella tubes). Mucous effusion dominated (62.44%). Ear tube placement alone was performed in more than half of cases (62.44%), while in 1/3 of patients the procedure was combined with adenoidectomy. Microscopically confirmed tympanic lesions indicative of advanced inflammation were found in 28 patients (13.14%). Conclusions. Although commonly accepted, tympanostomy tube insertion is not devoid of negative consequences. Possible complications include persistent tympanic perforation, tympanosclerosis, premature extrusion of an ear tube, ear discharge, tube obstruction and, in some cases, the need for surgical tube removal. Therefore, the procedure requires permanent and systematic otolaryngological care.

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

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.

Impact of Patient Socioeconomic Disparities on Time to Tympanostomy Tube Placement

2021 ◽  
pp. 000348942110157
Author(s):  
Jennifer L. McCoy ◽  
Ronak Dixit ◽  
R. Jun Lin ◽  
Michael A. Belsky ◽  
Amber D. Shaffer ◽  
...  
Keyword(s):  
Otitis Media ◽  
Otitis Media With Effusion ◽  
Private Insurance ◽  
Chronic Otitis Media ◽  
The United States ◽  
Socioeconomic Disparities ◽  
Tube Placement ◽  
Median Income ◽  
Public Insurance ◽  
Tympanostomy Tubes

Objectives: Extensive literature exists documenting disparities in access to healthcare for patients with lower socioeconomic status (SES). The objective of this study was to examine access disparities and differences in surgical wait times in children with the most common pediatric otolaryngologic surgery, tympanostomy tubes (TT). Methods: A retrospective cohort study was performed at a tertiary children’s hospital. Children ages <18 years who received a first set of tympanostomy tubes during 2015 were studied. Patient demographics and markers of SES including zip code, health insurance type, and appointment no-shows were recorded. Clinical measures included risk factors, symptoms, and age at presentation and first TT. Results: A total of 969 patients were included. Average age at surgery was 2.11 years. Almost 90% were white and 67.5% had private insurance. Patients with public insurance, ≥1 no-show appointment, and who lived in zip codes with the median income below the United States median had a longer period from otologic consult and preoperative clinic to TT, but no differences were seen in race. Those with public insurance had their surgery at an older age than those with private insurance ( P < .001) and were more likely to have chronic otitis media with effusion as their indication for surgery (OR: 1.8, 95% CI: 1.2-2.5, P = .003). Conclusions: Lower SES is associated with chronic otitis media with effusion and a longer wait time from otologic consult and preoperative clinic to TT placement. By being transparent in socioeconomic disparities, we can begin to expose systemic problems and move forward with interventions. Level of Evidence: 4

scholarly journals Tympanostomy Tubes for Otitis Media: Quality-of-Life Improvement for Children and Parents

2005 ◽  
Vol 84 (7) ◽  
pp. 418-424 ◽  
Author(s):  
Stanley Mui ◽  
Barry M. Rasgon ◽  
Raymond L. Hilsinger ◽  
Brent Lewis ◽  
Gretchen Lactao
Keyword(s):  
Quality Of Life ◽  
Otitis Media ◽  
Chart Review ◽  
Telephone Survey ◽  
Tympanostomy Tube ◽  
Tube Insertion ◽  
Health Maintenance ◽  
Cost Effective Treatment ◽  
Tympanostomy Tubes

We measured quality of life issues for both children and their parents on the premise that parental quality of life should be an aspect of cost-effectiveness in otitis media treatment. The patients were less than 18 years of age and had had myringotomy with tube insertion at the head and neck surgery department of a large health maintenance organization. Quality of life for patients, parents, and caregivers was evaluated by telephone survey of parents or caregivers and by retrospective chart review of the number of pre- and postoperative healthcare visits and antibiotic usage. Chart review showed a significant postoperative reduction in the number of clinic visits and in use of antibiotic drugs after insertion of tympanostomy tubes. Improved postoperative hearing was noted, and tympanostomy tube insertion was shown to be safe. The chart-review cost analysis showed that tympanostomy tube insertion is a cost-effective treatment for otitis media in children, and the telephone survey results showed that it improves quality of life for children and their parents or other caregivers.

Effect of vancomycin-coated tympanostomy tubes on methicillin-resistant Staphylococcus aureus biofilm formation: in vitro study

2010 ◽  
Vol 124 (6) ◽  
pp. 594-598 ◽  
Author(s):  
C H Jang ◽  
H Park ◽  
Y B Cho ◽  
C H Choi
Keyword(s):  
Staphylococcus Aureus ◽  
Biofilm Formation ◽  
Silver Oxide ◽  
In Vitro Study ◽  
Bacterial Biofilm ◽  
Tube Placement ◽  
Tympanostomy Tube ◽  
Methicillin Resistant ◽  
Tympanostomy Tubes

AbstractBackground and objective:Bacterial biofilm formation has been implicated in the high incidence of persistent otorrhoea after tympanostomy tube insertion. It has been suggested that the tube material may be an important factor in the persistence of such otorrhoea. Development of methicillin-resistant Staphylococcus aureus otorrhoea after tympanostomy tube placement is a growing concern. We evaluated the effect of using vancomycin and chitosan coated tympanostomy tubes on the incidence of methicillin-resistant Staphylococcus aureus biofilm formation in vitro.Materials and methods:Three sets each of vancomycin-coated silicone tubes (n = 5), commercial silver oxide coated silicone tubes (n = 5) and uncoated tympanostomy tubes (as controls; n = 5) were compared as regards resistance to methicillin-resistant Staphylococcus aureus biofilm formation after in vitro incubation.Results:Scanning electron microscopy showed that the surfaces of the silver oxide coated tubes supported the formation of thick biofilms with crusts, comparable to the appearance of the uncoated tubes. In contrast, the surface of the vancomycin-coated tympanostomy tubes was virtually devoid of methicillin-resistant Staphylococcus aureus biofilm.Conclusion:Vancomycin-coated tympanostomy tubes resist methicillin-resistant Staphylococcus aureus biofilm formation. Pending further study, such tubes show promise in assisting the control of methicillin-resistant Staphylococcus aureus biofilm formation.

Tympanostomy Tube Insertion: Anterosuperior vs. Anteroinferior Quadrant

1992 ◽  
Vol 106 (3) ◽  
pp. 241-242 ◽  
Author(s):  
Max M. April ◽  
Rafael R. Portella ◽  
Peter W. Orobello ◽  
Robert M. Naclerio
Keyword(s):  
Prospective Study ◽  
Type I ◽  
Tympanostomy Tube ◽  
Tube Insertion ◽  
Extrusion Rate ◽  
Tympanostomy Tubes ◽  
A Prospective Study

We studied the extrusion rate of Paparella type I tympanostomy tubes in the anterosuperior quadrant compared to those placed in the anteroinferior quadrant in a prospective study. Thirty-five patients were evaluated. The duration (mean ± SEM) in the anteroinferior quadrant was 211 ± 18 days, whereas the duration in the anterosuperior quadrant was 211 ± 11 days. We conclude that placement in the anterosuperior quadrant does not prolong duration of these tympanostomy tubes.

Water precautions and ear surgery: evidence and practice in the UK

2006 ◽  
Vol 121 (1) ◽  
pp. 9-14 ◽  
Author(s):  
S Basu ◽  
C Georgalas ◽  
P Sen ◽  
A K Bhattacharyya
Keyword(s):  
Current Practice ◽  
Tympanostomy Tube ◽  
National Guidelines ◽  
Tube Insertion ◽  
Ear Surgery ◽  
General Consensus ◽  
Tympanostomy Tubes ◽  
The Uk ◽  
National Practice ◽  
Harmful Effects

Background: Patients are traditionally advised to refrain from exposing their ears to water after most otological procedures. However, recent evidence suggests that water does not adversely affect the outcome for children with tympanostomy tubes. The evidence behind the potential harmful effects of water on the outcome of other otological procedures is scarce.Objective: The study was done to determine the current practice of otolaryngology consultants in the UK on the advice given to patients regarding swimming, diving and bathing in soapy water after myringotomy and tympanostomy tube insertion, mastoidectomy and myringoplasty.Method: Questionnaire based survey mailed to 382 members (consultants only) of the British Association of Otolaryngologists – Head & Neck Surgeons in the UK.Results: A total of 195 responses were received (reply rate 51 per cent). In all, 95.6 per cent of the respondents allowed their patients to swim after insertion of tympanostomy tubes, with 32.9 per cent insisting on the use of earplugs until extrusion of the tympanostomy tubes. However, 61.6 per cent of the respondents restricted diving in these patients. In comparison, the respondents were more conservative with water precautions following myringoplasty and mastoidectomy. More than half the respondents recommended earplugs for bathing after all three operations.Conclusion: This study reveals current national practice among UK otolaryngologists. There is no general consensus in post-operative advice following otolaryngological procedures, indicating a need for national guidelines.

scholarly journals Retained Tympanostomy Tubes: Who, What, When, Why, and How to Treat?

2020 ◽  
pp. 014556132095049
Author(s):  
Margaret Michel ◽  
Gabriel Nahas ◽  
Diego Preciado
Keyword(s):  
English Language ◽  
Medical Literature ◽  
Tube Placement ◽  
Tissue Formation ◽  
Tympanostomy Tube ◽  
Granulation Tissue Formation ◽  
Guiding Principle ◽  
Language Studies ◽  
Tube Removal ◽  
Tympanostomy Tubes

Background: Tympanostomy tube placement is one of the most common surgical procedures performed across the globe. Controversies exist regarding what to do when a tube is considered to be retained in the tympanic membrane for too long. Materials and Methods: Review of the PubMed medical literature starting in 1990, focusing on English language studies reporting on the definition, complications, and management of retained tympanostomy tubes. Results: The medical literature reporting on outcomes regarding retained tympanostomy tubes is relatively sparse. Most studies recommend prophylactic removal of tubes after a defined period of time, usually around 2 to 3 years after placement. A preferred method of myringoplasty after tympanostomy tube retrieval has not been established, but most studies recommend grafting the perforation at the time of tube removal. Conclusions: Although a consensus as to the optimal management of retained tympanostomy tubes is not yet established in the medical literature, a preponderance of studies recommend prophylactic removal at defined period of time (>2-3 years) before the onset of complications such as otorrhea and granulation tissue formation. Due to a lack of best evidence, the surgeon’s preference remains the guiding principle as to the best technique for myringoplasty at the time of removal.

scholarly journals Tympanostomy Tubes—A Visual Guide for the Young Otolaryngologist

2020 ◽  
Vol 99 (1_suppl) ◽  
pp. 8S-14S
Author(s):  
Glenn Isaacson
Keyword(s):  
Clinical Practice ◽  
Correct Diagnosis ◽  
Acute Otitis Media ◽  
Tube Placement ◽  
Tympanostomy Tube ◽  
Shared Experience ◽  
Tube Removal ◽  
Recurrent Acute Otitis Media ◽  
Tympanostomy Tubes ◽  
The Common

Objectives: To illustrate some of the common dilemmas in tympanostomy tube care and describe time-tested ways to address them. Methods: Computerized literature review. Results: Issues including the correct diagnosis of recurrent acute otitis media, tympanostomy tube types and techniques for tube placement, management of tube clogging and otorrhea, and methods for tube removal and patching are illustrated. Conclusions: Tympanostomy tube placement is the most common surgery performed in children requiring general anesthesia. While some elements of tympanostomy tube care have been addressed in clinical studies, much of clinical practice is guided by shared experience.

Can Catastrophic Long-Term Care Insurance Policies Increase Private Insurance Coverage and Reduce Medicaid Expenditure?

2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Guoxuan Ma ◽  
Wei Sun
Keyword(s):  
Long Term Care ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Purchase Decisions ◽  
Term Care ◽  
Middle Income ◽  
Insurance Policies ◽  
Long Term Care Insurance ◽  
Care Costs

Abstract Using an inter-temporal optimization model of long-term care insurance purchase decisions, we evaluate catastrophic long-term care insurance policies that cover the tail risk of long-term care costs at affordable premiums. Under our baseline model, we show theoretically that introducing catastrophic policies will induce 11 percent of middle-income men and 3 percent of middle-income women to initiate private insurance coverage. As a result, Medicaid costs will be reduced by 0.20 percent and 0.19 percent for men and women, respectively.

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