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.

Preventing Otitis Media

1994 ◽  
Vol 103 (5_suppl) ◽  
pp. 20-23 ◽  
Author(s):  
G. Scott Giebink
Keyword(s):  
Otitis Media ◽  
Otitis Media With Effusion ◽  
Antimicrobial Prophylaxis ◽  
Acute Otitis Media ◽  
Tympanostomy Tube ◽  
Tube Insertion ◽  
Protein Conjugate ◽  
Recurrent Acute Otitis Media ◽  
Prevalent Disease ◽  
The Common

Recurrent acute otitis media (AOM) is an extremely prevalent disease in young children. Epidemiologic associations suggest that primary prevention or reduction of AOM frequency may be achieved with breast-feeding during infancy, elimination of household tobacco smoking, and use of small rather than large day-care arrangements for infants and toddlers. Secondary antimicrobial prophylaxis with amoxicillin or sulfisoxazole reduces the frequency of recurrent AOM by about 50%, but it does not appear to reduce the duration of otitis media with effusion (OME). Tympanostomy tube insertion is not as effective as amoxicillin in reducing AOM frequency in children without OME. Adenoidectomy appears to be warranted for children who develop recurrent AOM after extrusion of tubes. Vaccines against the common bacteria and viruses causing AOM hold the greatest promise of preventing AOM and blocking the sequence of pathologic events leading to chronic OME and middle ear sequelae. The greatest progress has been made recently with pneumococcal protein conjugate vaccines, and clinical testing is in progress.

Second tympanostomy tube placement in children with recurrent acute otitis media

2017 ◽  
Vol 128 (6) ◽  
pp. 1476-1479 ◽  
Author(s):  
Phillip Huyett ◽  
Joshua J. Sturm ◽  
Amber D. Shaffer ◽  
Dennis J. Kitsko ◽  
David H. Chi
Keyword(s):  
Otitis Media ◽  
Acute Otitis Media ◽  
Tube Placement ◽  
Tympanostomy Tube ◽  
Recurrent Acute Otitis Media

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.

Tympanostomy Tube Placement vs Medical Management for Recurrent Acute Otitis Media in TRICARE-Insured Children

2017 ◽  
Vol 157 (5) ◽  
pp. 867-873 ◽  
Author(s):  
Nikhila Raol ◽  
Meesha Sharma ◽  
Emily F. Boss ◽  
Wei Jiang ◽  
John W. Scott ◽  
...  
Keyword(s):  
Otitis Media ◽  
Medical Management ◽  
Acute Otitis Media ◽  
Tube Placement ◽  
Tympanostomy Tube ◽  
Recurrent Acute Otitis Media

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.

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.

Extensive Acquired Cholesteatoma in Children: When the Penny Drops

2005 ◽  
Vol 114 (7) ◽  
pp. 539-542 ◽  
Author(s):  
Craig W. Semple ◽  
Murali Mahadevan ◽  
Robert G. Berkowitz
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Acute Otitis Media ◽  
Retrospective Chart Review ◽  
Computed Tomographic ◽  
Recurrent Acute Otitis Media ◽  
Tympanostomy Tubes ◽  
Acquired Cholesteatoma ◽  
High Index Of Suspicion ◽  
Conductive Hearing

Objectives: To determine the factors associated with the diagnosis of acquired cholesteatoma (AC) in children, we performed a retrospective chart review at a tertiary care center. Methods: We reviewed children with a diagnosis of AC that extended beyond the mesotympanum in the presence of a nonintact tympanic membrane who underwent surgical treatment over a 14-year period. Results: There were 116 children (78 male, 38 female) between 3 and 18 years of age (mean, 9.5 years). Their average period of management in a specialist otolaryngology clinic before the diagnosis of cholesteatoma was made was 3.2 years, and 68% of the children had previously undergone insertion of tympanostomy tubes. Symptoms and signs included chronic otorrhea (59%), recurrent acute otitis media (58%), and conductive hearing loss (51%). The diagnosis of AC was eventually made after office otoscopy (26%), temporal bone computed tomography (24%), or examination under anesthesia (17%). In 33% of children, the diagnosis was made only after surgical exploration of the middle ear and mastoid. Conclusions: Our data underscore the importance of maintaining a high index of suspicion for AC in managing children with long-standing otologic symptoms, and considering otomicroscopy, computed tomographic scanning, or tympanomastoid exploration if medical treatment fails.

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