scholarly journals Tympanostomy Tube Obstruction Related to Ototopical Drug Therapy

2005 ◽  
Vol 84 (7) ◽  
pp. 416-417 ◽  
Author(s):  
Marc K. Bassim ◽  
Amelia F. Drake
Keyword(s):  
Drug Therapy ◽  
Tube Placement ◽  
Tympanostomy Tube ◽  
Ventilation Tube ◽  
Significant Complication ◽  
Tube Obstruction ◽  
Tympanostomy Tubes ◽  
Placement Procedure

Obstruction of tympanostomy tubes is a potentially significant complication, sometimes requiring replacement of the nonfunctioning tube. Early blockage can occur secondary to bleeding during the tube placement procedure. Delayed obstruction is usually caused by inspissated secretions or epithelial casts. We briefly report our treatment of 9 cases of delayed ventilation tube obstruction that were associated with the use of an ototopical antibiotic/steroid suspension.

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 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.

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.

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.

Steroid Versus Antibiotic Drops in the Prevention of Postoperative Myringotomy Tube Complications

2018 ◽  
Vol 127 (7) ◽  
pp. 445-449 ◽  
Author(s):  
Sameer A. Alvi ◽  
Joel W. Jones ◽  
Paul Porter ◽  
Mollie Perryman ◽  
Karen Nelson ◽  
...  
Keyword(s):  
Topical Therapy ◽  
Retrospective Chart Review ◽  
Cost Effective ◽  
Tube Placement ◽  
Tympanostomy Tube ◽  
Tube Obstruction ◽  
Dexamethasone Group ◽  
Significant Difference ◽  
P 16

Objectives: To determine the incidence of early postoperative tympanostomy tube insertion otorrhea and obstruction in pediatric patients receiving antibiotic ear drops with or without steroid perioperatively. Methods: A retrospective chart review was performed on patients who underwent outpatient myringotomy and tube placement. Patients from June 2013 to February 2014 received ciprofloxacin/dexamethasone perioperatively while patients from May 2014 to April 2015 received ofloxacin. Statistical analysis was performed to compare outcomes between the cohorts. Results: One hundred thirty-four patients received topical ciprofloxacin/dexamethasone, and 116 patients received topical ofloxacin. The rate of postoperative otorrhea was 5.2% for the ciprofloxacin/dexamethasone group and 8.2% for the ofloxacin group. Tube obstruction was seen in 6.0% of the ciprofloxacin/dexamethasone group and 5.2% in the ofloxacin group. Neither outcome had a statistically significant difference ( P = .21 and .85, respectively). There was no difference in the rate of effusion at the time of tube placement between the 2 cohorts ( P = .16), and this included subgroup analysis based on effusion type (mucoid, purulent, serous). Patients with a mucoid effusion at the time of surgery were more likely to experience otorrhea/obstruction than patients with dry ears (odds ratio = 2.23, P = .02). Conclusion: No significant difference in the incidence of immediate postoperative tympanostomy tube otorrhea or obstruction was seen between the antibiotic-steroid and antibiotic alone cohorts, regardless of effusion type. Overall, patients with mucoid effusions are more likely to develop tube otorrhea or obstruction at follow-up. Cost-effective drops should be used when prescribing topical therapy to prevent complications after ear tubes.

Post-Tympanostomy Otorrhea: A Randomized Clinical Trial of Topical Prophylaxis

1992 ◽  
Vol 106 (1) ◽  
pp. 34-41 ◽  
Author(s):  
Bruce A. Scott ◽  
Chester L. Strunk
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Middle Ear ◽  
Tube Placement ◽  
Tympanostomy Tube ◽  
Treatment Groups ◽  
Time Of Surgery ◽  
Significant Difference ◽  
Tympanostomy Tubes ◽  
Prophylactic Use

Myringotomy with the insertion of tympanostomy tubes has become the most frequently performed otolaryngologic procedure, and otorrhea is the most common post-tympanostomy complication. Many otolaryngologists routinely use prophylactic topical antibiotic solutions when performing tympanostomy tube placement. Relatively little has been written regarding early post-tympanostomy otorrhea and scarcely any examining the efficacy of such prophylaxis. The current study is a randomized clinical trial to critically evaluate the efficacy of prophylactic otic drops after tympanostomy tube placement. The ototoxic potential of these solutions, combined with constant pressures to decrease medication expenses and eliminate unnecessary use of antibiotics, makes determination of the shortest effective course of application paramount. Subjects were randomized at the time of surgery into one of three groups; one group received no prophylaxis, a second group received gentamicin otic drops Immediately after tympanostomy tube placement in the operating room only, and the third group received an additional 48 hours of drops (4 drops in each ear, three times a day). All patients were seen within 2 weeks postoperatively. An overall early post-tympanostomy otorrhea incidence of 8.7% is documented with 12%, 8.8%, and 5.6% for each study group, respectively. While these findings may suggest possible efficacy of topical prophylaxis, a statistically significant difference between the treatment groups was not proved ( p = 0.62). Further analysis by subdivision of the patients, on the basis of middle ear cavity finding at the time of surgery, reveals a highly significant statistical association of the occurrence of post-tympanostomy otorrhea in ears having mucoid effusions ( p < 0.001) as compared to ears without effusion or with serous effusions. On the basis of the results of this randomized trial, the routine prophylactic use of potentially ototoxic topical solutions does not appear to be Justified in patients found to have a middle ear cleft that is dry or has a serous effusion. Patients found to have mucoid effusions are at statistically significantly higher risk of development of otorrhea postoperatively. Use of prophylactic otic drops may be indicated in this group.

scholarly journals Suppurative otitis media after tympanostomy tube placement

2003 ◽  
Vol 56 (9-10) ◽  
pp. 457-459
Author(s):  
Ivan Baljosevic ◽  
Vladan Subarevic ◽  
Nikola Mircetic ◽  
Jovana Jecmenica ◽  
Jovica Karanov ◽  
...  
Keyword(s):  
Otitis Media ◽  
Tube Placement ◽  
Upper Respiratory Tract ◽  
Tympanostomy Tube ◽  
Oral Antibiotics ◽  
Suppurative Otitis Media ◽  
Mother And Child Health ◽  
Tympanostomy Tubes ◽  
Mother And Child ◽  
Early Late

Suppurative otitis media after tympanostomy tube placement is the most frequent complication of this surgical intervention. Otorrhea that occurs in the first two weeks following tube placement is called early, late otorrhea occurs at least two weeks following placement. Early otorrhea is usually a result of either an infection that already existed when the tube was placed, or contamination of the external auditory canal during operation. Late otorrhea is mostly a result of upper respiratory tract infection. Material and methods Our investigation was performed at the ENT Department, Mother and Child Health Care Institute in Belgrade. The research included children treated for secretory or recurrent otitis media. Results and discussion We have examined 411 children implanted with 796 tympanostomy tubes in the last three years. We investigated changes within two weeks after operation. Suppuration was recorded with 81 children (19.7%). Staphylococcus aureus was established in 33 (40.7%) Pseudomonas aeruginosa in 26 (32%), Haemophilus influenzae in 12 (15%) and Streptococcus pneumoniae in 10 (12.3%) cases. All children were treated with antibiotic ear drops according to the antibiogram for a period of 7 days. Full recovery was achieved after treatment with Ciprofloxacin drops in 67%, Neomycin in 18% and Gentamycin in 9% of cases. In other cases a combination of drops and oral antibiotics was used. Conclusion In cases of suppurative otitis media after implantation of tympanostomy tubes, the secret should be treated with suction and after that antibiotic drops should be applied during 5 to 7 days. If suppuration is persistent, drops should be used with oral antibiotics.

Downward Trend in Resident Myringotomy and Tympanostomy Tube Experience

2021 ◽  
pp. 000348942110474
Author(s):  
Sarah M. Dermody ◽  
Stephanie Y. Johng ◽  
Mariel O. Watkins ◽  
Sonya Malekzadeh ◽  
Jaeil Ahn ◽  
...  
Keyword(s):  
Surgical Training ◽  
Chronic Otitis Media ◽  
Resident Training ◽  
Tube Placement ◽  
Tympanostomy Tube ◽  
National Data ◽  
Training Experience ◽  
Multiple Factors ◽  
The Past ◽  
Tympanostomy Tubes

Introduction/Objective: Historically, myringotomy, and the insertion of tympanostomy tubes has served as one of the initial surgical training experiences for residents. Resident experience with this procedure since the introduction of pneumococcal conjugate vaccines has not been well described in the literature. The objective of this study was to identify trends in resident training experience with chronic otitis media-related surgeries, such as myringotomy and tympanostomy tube placement. While multiple factors influence resident experience, we hypothesize that resident experience has decreased since the introduction of the pneumococcal 13-valent conjugate vaccine (PCV13). Methods and Materials: In a retrospective review of Accreditation Council for Graduate Medical Education (ACGME) National Data Reports, mean number of myringotomy and tympanostomy tube cases logged in the Resident Case Log System from 2006 to 2019 were collated and plotted against years to identify monotonic trends. Mann-Whitney U test was used to compare pre-PCV13 era and post-PCV13 era data. Results: Since the introduction of PCV13, there is a national decreasing trend in the myringotomy and tympanostomy tube placement by otolaryngology residents ( P = .001). Conclusions: Otologic surgeries are an important part of resident education and historically have served as one of the initial surgical training experiences for residents. There has been a significant reduction in the number of myringotomy and tympanostomy procedures performed by otolaryngology residents in the past decade. While multiple factors influence resident experience, it is possible that introduction of PCV13 has impacted resident exposure to myringotomy and tympanostomy tube placement. Resident proficiency with this procedure has likely not been affected by introduction of PCV13. Data should be reassessed in 5 years to determine if an impact of the PCV13 vaccine on resident training is evident.

Early Otorrhea Rates: A Randomized Trial of Ciprofloxacin versus Saline Drops after Tympanostomy Tubes

2019 ◽  
Vol 128 (8) ◽  
pp. 760-766 ◽  
Author(s):  
Gabriel Gabarain ◽  
Rachel Baird ◽  
Megan Morisada ◽  
Samantha Anne ◽  
Brandon Hopkins
Keyword(s):  
Quality Of Life ◽  
Normal Saline ◽  
Perioperative Period ◽  
Antibiotic Use ◽  
Tube Placement ◽  
Tympanostomy Tube ◽  
Level Of Evidence ◽  
Tympanostomy Tubes

Objective: The objectives of this study are to evaluate incidence, duration, and quality of life (QOL) impact of early tympanostomy tube otorrhea and tube patency when comparing topical ciprofloxacin versus normal saline use in the perioperative period. Methods: Overall, 200 patients undergoing tube placement between November 19, 2015, and September 12, 2016, were randomized to intraoperative plus 5 days of either topical ciprofloxacin or normal saline. Parents or caregivers reported the incidence, duration, and QOL impact of early otorrhea via 4 weekly surveys. In addition, the patient’s otorrhea history and tube patency were evaluated at a 4- to 6-week postoperative visit. Results: Survey and in-office follow-ups were completed on 128 patients. The overall otorrhea incidence was 23.9% for normal saline and 16.7% for ciprofloxacin ( P = .32). The week-by-week otorrhea incidence was not statistically different. The percentage of days otorrhea was present, likewise, was not statistically different (normal saline 4.5%, ciprofloxacin 2.8%; P = .74). The QOL impact was not statistically different (normal saline 1.2, ciprofloxacin 1.5; P = .71). Tube patency was not statistically different, with only 1 of 280 ears occluded at follow-up. Conclusion: We find no difference in the incidence, duration, and QOL impact of early tympanostomy tube otorrhea or tube patency between ciprofloxacin and normal saline. This supports the option to substitute normal saline for ciprofloxacin in ears without an active ear infection at the time of tube placement, which would reduce both cost and unnecessary antibiotic use. Level of Evidence: 1b

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