Suppurative otitis media after tympanostomy tube placement

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.

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Microbiology of Acute Otitis Media with Tympanostomy Tubes

Otolaryngology ◽

10.1016/j.otohns.2005.07.015 ◽

2005 ◽

Vol 133 (4) ◽

pp. 585-595 ◽

Cited By ~ 33

Author(s):

Peter S. Roland ◽

David A. Parry ◽

David W. Stroman

Keyword(s):

Staphylococcus Aureus ◽

Pseudomonas Aeruginosa ◽

Otitis Media ◽

Acute Otitis Media ◽

Tympanostomy Tube ◽

Oral Antibiotics ◽

Streptococcus Pneumonia ◽

Tympanostomy Tubes ◽

Fungal Organisms ◽

Ear Drops

OBJECTIVE: The objective was to determine the types of organisms which cause acute otitis media with a tympanostomy tube and to ascertain their frequency distribution. STUDY DESIGN AND SETTING: Prospective, randomized, multi-institutional clinical trials. Both private and academic sites were included. RESULTS: 1309 isolates were recovered from 956 draining ears. Streptococcus pneumonia was recovered from 17%, Staphylococcus aureus from 13%, H flu from 18% and Pseudomonas aeruginosa from 12%. Fungal organisms were recovered from 5% of total isolates and 4% from single isolates. CONCLUSIONS: AOMT is microbiologically different than AOM with an intact TM. There is no evidence that resistance develops as result of topical treatment. SIGNIFICANCE: The study demonstrates that AOMT is frequently caused by organisms not susceptible to oral antibiotics approved for children, but which are sensitive to topical ear drops.

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Indications for tympanostomy tube insertion in children

New Medicine ◽

10.25121/newmed.2019.23.2.49 ◽

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.

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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.

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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.

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Impact of Patient Socioeconomic Disparities on Time to Tympanostomy Tube Placement

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211015741 ◽

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

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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.

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Microbiology of Chronic Suppurative Otitis Media in Children

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894880970s204 ◽

1988 ◽

Vol 97 (2_suppl) ◽

pp. 9-15 ◽

Cited By ~ 5

Author(s):

Margaret A. Kenna

Keyword(s):

Pseudomonas Aeruginosa ◽

Otitis Media ◽

Medical Therapy ◽

Intravenous Administration ◽

Initial Treatment ◽

Viable Alternative ◽

Tympanostomy Tube ◽

Suppurative Otitis Media ◽

Mastoid Surgery ◽

Standard Techniques

The aerobic microorganisms present in 57 MEs of 40 children with C Supp OM without cholesteatoma were evaluated. Specimens were taken directly from the ME through a patent perforation or tympanostomy tube and cultured using standard techniques. Twenty-six organisms were identified, with Pseudomonas aeruginosa being the most prevalent (65% of ears) and the only organism in 30% of ears. The initial treatment of all patients was intravenous administration of an antimicrobial selected on the basis of culture and susceptibility reports. This treatment was successful in all but four children, who subsequently required tympanomastoid surgery. These results indicate that the microbiology of C Supp OM is similar to that in patients with cholesteatoma. However, based on the results of culture and susceptibility studies, medical therapy provides a viable alternative to major mastoid surgery in the management of C Supp OM without cholesteatoma.

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

Ear Nose & Throat Journal ◽

10.1177/014556130508400712 ◽

2005 ◽

Vol 84 (7) ◽

pp. 418-424 ◽

Cited By ~ 14

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.

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

The Journal of Laryngology & Otology ◽

10.1017/s0022215109992672 ◽

2010 ◽

Vol 124 (6) ◽

pp. 594-598 ◽

Cited By ~ 16

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.

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Middle Ear Cilia Activity as a Determinant of Tympanostomy Tube Placement

Otolaryngology ◽

10.1177/019459988609500403 ◽

1986 ◽

Vol 95 (4) ◽

pp. 434-437 ◽

Cited By ~ 8

Author(s):

Douglas F. Wacker ◽

Maridel L. Howe

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Tube Placement ◽

Tympanostomy Tube ◽

Future Health ◽

The Future ◽

Ventilating Tubes ◽

Serous Otitis Media ◽

Inferior Quadrant

Three hundred and twenty-six patients with diagnoses of serous otitis media—or mucold otitis medid—were reviewed for the presence or absence of middle ear cilia activity. This study strongly suggests that if active cilia can be observed, ventilating tubes are not needed. This easily observed activity in the anterior-inferior quadrant offers the otolaryngologist an accurate tool for determination of the future health of the middle ear.

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