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Wie K, Shaw S, Allen P, Castle M, McKenna M, Faria J. Risk Factors for Replacement of Tympanostomy Tubes After Surgical Removal for Pediatric Patients. Otolaryngol Head Neck Surg 2024. [PMID: 39015070 DOI: 10.1002/ohn.909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 06/11/2024] [Accepted: 07/05/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVES Ear tube removal and patch myringoplasty are frequently performed. The indication and timing for surgery varies among otolaryngologists. This study identifies risk factors associated with the need for the replacement of tympanostomy tubes after tube removal and myringoplasty. STUDY DESIGN Case series with chart review. SETTING Single institution academic otolaryngology practice. METHODS Patients younger than 12 years of age who underwent tympanostomy tube removal and myringoplasty at the University of Rochester Medical Center from March 2011 to September 2019. Patients with tympanostomy tube removal due to chronic otorrhea were excluded. RESULTS One hundred sixty-one patients (230 ears) met inclusion criteria and had sufficient follow-up. Myringoplasty success after tube removal was 94.8%. Successful myringoplasty was associated with shorter tube duration (32 months) versus unsuccessful myringoplasty (40 months) (P = .02). Replacement tympanostomy tubes after myringoplasty occurred in 9.6% of ears. There was no difference in average patient age (P = .96) or duration of tubes (P = .74) in patients who required replacement of tympanostomy tubes versus patients who did not require tube replacement. Patients with a cleft abnormality were more likely to require tympanostomy tube replacement (P < .001). CONCLUSIONS Most children do not need tubes replaced after removal. This study identified cleft abnormality as a factor that increased the need for replacement tubes. Longer tube durations of over 3 years negatively impacted myringoplasty success. Tympanostomy tube removal should be considered 2 to 3 years after placement in most patients with longer tube durations considered in children with a repaired cleft palate.
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Affiliation(s)
- Kathryn Wie
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
| | - Shalini Shaw
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Paul Allen
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
| | - Michael Castle
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
| | - Margo McKenna
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
| | - John Faria
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
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Thornton NJ, Isaacson G. Elective Tympanostomy Tube Removal at 2.5 Years: Results of a Protocol for Retained Tubes. Laryngoscope 2024; 134:439-442. [PMID: 37204082 DOI: 10.1002/lary.30751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/28/2023] [Accepted: 05/03/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVES In 2001, we instituted a protocol for the removal of retained tympanostomy tubes, delaying elective removal until 2.5 years after placement. It was hoped that this would decrease the number of surgeries without increasing the rate of permanent tympanic perforations compared to removal at 2 years. METHODS Protocol: Fluoroplastic Armstrong beveled grommet tympanostomy tubes were placed by a single surgeon supervising the residents. The children were seen at 6-month intervals after placement. Children with a retained tympanostomy tube(s) at 2 years were seen again at 2.5 years, and the retained tubes were removed under general anesthesia with patch application. All were evaluated 4 weeks after surgery by otoscopy, otomicroscopy, behavioral audiometry, and tympanometry. STUDY A computerized collection of patient letters and operative reports was queried to identify children treated according to the protocol between 2001 and 2022. Those with examinations at 2 years ± 1 month and 2.5 years ± 1 month and complete follow-up were included. RESULTS Of the 3552 children with tympanostomy tubes, 497 (14%) underwent tube removal. One-hundred and forty seven children fit the strict inclusion criteria. Among those with retained tubes at 2 years, 67/147 (46%) had lost any remaining tube or tubes at 2.5 years and did not need surgery, 80/147 (54%) required unilateral or bilateral tube removal, 9/147 (6%) had a persistent perforation at 1-year follow-up, and 4/147 children (3%) required tympanic re-intubation after either spontaneous extrusion or removal and patching at 2.5 years. CONCLUSIONS Delaying tympanostomy tube removal until 2.5 years can cut the need for surgery in half with, an acceptable (6%) incidence of persistent perforations. LEVEL OF EVIDENCE Four case series-historical control Laryngoscope, 134:439-442, 2024.
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Affiliation(s)
- Noah J Thornton
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, U.S.A
| | - Glenn Isaacson
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, U.S.A
- Department of Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, U.S.A
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Ha J, Gu GY, Yeou SH, Kim H, Choo OS, Jang JH, Park HY, Choung YH. Determination of Tympanostomy Tube Types for Otitis Media with Effusion in Patients with Cleft Palate: Comparison between Paparella Type 1 and Type 2 Tubes. J Clin Med 2023; 12:6651. [PMID: 37892790 PMCID: PMC10607012 DOI: 10.3390/jcm12206651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 09/30/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
This study examined the effects of different types of tympanostomy tubes in pediatric patients undergoing cleft palate (CP) surgery in order to provide guidance for the proper insertion of tympanostomy tubes in the management of otitis media with effusion (OME). A total of 101 ears with middle ear effusion in 51 patients with CP were included in this study. Patients underwent palatoplasty and tympanostomy tube surgery at the same time. The type of tube inserted (Paparella type 1 or 2), the severity of CP, and types of palatoplasty surgeries were investigated. All patients were followed up for at least 6 months, and recurrence rates, complications, and reinsertion surgery were evaluated. The rate of OME recurrence after spontaneous tube extrusion was significantly higher in the type 1 group than in the type 2 group (44.3% vs. 19.4%, respectively, p = 0.016). Persistent eardrum perforation was more common in the type 2 group than in the type 1 group (41.9% vs. 12.9%, respectively, p = 0.001). The tube reinsertion rate was higher in the type 1 group than in the type 2 group (22.9% vs. 3.2%, respectively, p = 0.015). The tube reinsertion rate decreased to 8.6% in cases of palatoplasty with Sommerlad's technique, even with type 1 tube insertion, which was not significantly different from the reinsertion rate in the type 2 group (3.7%, p = 0.439). The Paparella type 1 tube would be a better choice in cases of palatoplasty performed using Sommerlad's technique, particularly considering the higher rate of persistent eardrum perforation after extrusion associated with the Paparella type 2 tube. Alternatively, a larger size type 2 tube may be considered in other surgeries to decrease the frequency of recurrence and tube reinsertion.
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Affiliation(s)
- Jungho Ha
- Department of Otolaryngology, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.H.); (G.Y.G.); (S.H.Y.); (J.H.J.); (H.Y.P.)
- Department of Medical Sciences, Ajou University Graduate School of Medicine, Suwon 16499, Republic of Korea; (H.K.); (O.-S.C.)
| | - Ga Young Gu
- Department of Otolaryngology, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.H.); (G.Y.G.); (S.H.Y.); (J.H.J.); (H.Y.P.)
- Department of Medical Sciences, Ajou University Graduate School of Medicine, Suwon 16499, Republic of Korea; (H.K.); (O.-S.C.)
| | - Se Hyun Yeou
- Department of Otolaryngology, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.H.); (G.Y.G.); (S.H.Y.); (J.H.J.); (H.Y.P.)
- Department of Medical Sciences, Ajou University Graduate School of Medicine, Suwon 16499, Republic of Korea; (H.K.); (O.-S.C.)
| | - Hantai Kim
- Department of Medical Sciences, Ajou University Graduate School of Medicine, Suwon 16499, Republic of Korea; (H.K.); (O.-S.C.)
- Department of Otorhinolaryngology, Konyang University College of Medicine, Daejeon 35365, Republic of Korea
| | - Oak-Sung Choo
- Department of Medical Sciences, Ajou University Graduate School of Medicine, Suwon 16499, Republic of Korea; (H.K.); (O.-S.C.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Jeong Hun Jang
- Department of Otolaryngology, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.H.); (G.Y.G.); (S.H.Y.); (J.H.J.); (H.Y.P.)
| | - Hun Yi Park
- Department of Otolaryngology, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.H.); (G.Y.G.); (S.H.Y.); (J.H.J.); (H.Y.P.)
| | - Yun-Hoon Choung
- Department of Otolaryngology, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.H.); (G.Y.G.); (S.H.Y.); (J.H.J.); (H.Y.P.)
- Department of Medical Sciences, Ajou University Graduate School of Medicine, Suwon 16499, Republic of Korea; (H.K.); (O.-S.C.)
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Takai S, Nomura K, Oda K, Ozawa D, Irimada M, Ikeda R, Kakuta R, Katori Y, Ohyama K. Clinical Factors Associated With the Outcomes of Long-Term Middle Ear Ventilation Tube Insertion in Pediatric Patients. EAR, NOSE & THROAT JOURNAL 2023; 102:NP511-NP517. [PMID: 34130509 DOI: 10.1177/01455613211026437] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Ventilation tube (VT) insertion is the most common treatment for otitis media with effusion (OME). However, OME recurrence and persistent tympanic membrane (TM) perforation after VT removal are encountered in a certain percentage of such children. METHODS This study was performed to determine the outcomes of children who underwent long-term VT insertion. A total of 326 ears from 192 patients were analyzed. The associations among the patient age, sex, history of OME, history of repeated acute otitis media, placement duration, whether the VT had been removed intentionally or spontaneously, and the outcome (persistent TM perforation or OME recurrence) were analyzed. The outcomes of multiple VT tube insertions were also reviewed. We also analyzed whether or not local or general anesthesia was associated with the early spontaneous extrusion of the VT. RESULT The OME recurrence and TM perforation rates were 29% (96/326 sides) and 17% (57/326 sides), respectively, for first insertions. In addition, 96 (29%) sides underwent ≥2 insertions. The shorter the duration for which the VT was retained in the middle ear, the more significant the rate of increase in OME recurrence. The OME recurrence was observed more often when VT was spontaneously removed than when intentionally removed. The rate of persistent TM perforation was significantly associated with male sex. Persistent TM perforation was not observed in patients who underwent 4 or 5 insertions. The anesthesia method did not significantly influence the timing of spontaneous extrusion of VT. CONCLUSION The retention period of VT should be at least 2 years, and VT removal at the age of 7 might be a viable strategy. Multiple VT insertions are recommended for patients with recurrent OME. Ventilation tube under local anesthesia is an effective option for tolerable children.
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Affiliation(s)
- Shunsuke Takai
- Department of Otolaryngology, Tohoku Rosai Hospital, Dainohara, Aoba-ku, Sendai, Miyagi, Japan
| | - Kazuhiro Nomura
- Department of Otolaryngology, Tohoku Rosai Hospital, Dainohara, Aoba-ku, Sendai, Miyagi, Japan
- Department of Otolaryngology, Tohoku Kosai Hospital, Kokubun-cho, Aoba-ku, Sendai-shi, Miyagi, Japan
| | - Kiyoshi Oda
- Department of Otolaryngology, Tohoku Rosai Hospital, Dainohara, Aoba-ku, Sendai, Miyagi, Japan
| | - Daiki Ozawa
- Department of Otolaryngology, Tohoku Rosai Hospital, Dainohara, Aoba-ku, Sendai, Miyagi, Japan
| | - Mihoko Irimada
- Department of Otolaryngology, Tohoku Rosai Hospital, Dainohara, Aoba-ku, Sendai, Miyagi, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Risako Kakuta
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Kenji Ohyama
- Department of Otolaryngology, Tohoku Rosai Hospital, Dainohara, Aoba-ku, Sendai, Miyagi, Japan
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Laser, radiofrequency or tympanostomy knife? Comparison of surgical methods in tympanostomy treatment of young children and predictive value of tympanometry. Int J Pediatr Otorhinolaryngol 2023; 165:111443. [PMID: 36630866 DOI: 10.1016/j.ijporl.2023.111443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/22/2022] [Accepted: 01/06/2023] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To investigate tympanostomy tube (TT) treatment in young children, with special interest in bloodless surgical methods (laser and radiofrequency), myringosclerosis formation and tympanometric testing. METHODS This prospective study includes 76 children whose 121 ears with middle ear effusion were treated with tympanostomy tubes. Myringotomy was performed with CO2 laser in 37, radiofrequency in 40 and myringotomy knife in 44 ears. The ears were evaluated with otomicroscopy and tympanometry preoperatively and postoperatively every 3-4 months until spontaneous tube extrusion. RESULTS All tubes extruded spontaneously (mean 12.8 months, range 3-36 months), with no persistent perforations or cholesteatomas. CO2 laser and radiofrequency inserted tympanostomy tubes extruded faster (mean 11 months) compared to incisional myringotomy (mean 15 months, p = 0.002). Myringosclerosis was noted in 25 (21%) ears after treatment. There was a tendency to less myringosclerosis with bloodless techniques, but the difference was not significant. Flat tympanograms on the day of procedure predicted continuation of ventilation problems also after TT treatment (p = 0.003). Ears with preoperative type B tympanogram had significantly more myringosclerosis 21/75 (28%) compared with type A and C tympanograms 4/41 (10%) (p = 0.032). CONCLUSIONS While all myringotomy methods were effective and safe, the traditional incisional myringotomy with a tympanostomy knife is still a good, feasible and cost-effective myringotomy method. No surgical removal of tympanostomy tubes is needed before 3 years of uncomplicated tympanostomy treatment. Tympanometry turned out to be a useful tool in prediction of post TT treatment ventilation problems of the middle ear.
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Otsuka S, Imai R, Kamakura T, Nishimura H, Osaki Y, Furukawa M, Yasui T, Yamashita M, Nakamura M, Iwamoto Y, Kanazu K, Yonei S, Okazaki S, Hirose M. How long do tympanostomy ventilation tubes last in pediatric patients with otitis media with effusion or adhesion? A study using Kaplan-Meier survival analysis. Int J Pediatr Otorhinolaryngol 2022; 159:111210. [PMID: 35724491 DOI: 10.1016/j.ijporl.2022.111210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/26/2022] [Accepted: 06/09/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the functional duration and survival rate of tympanostomy ventilation tubes and the complications associated with their use in pediatric patients who underwent tube insertion for otitis media with effusion (OME). Complications were analyzed including recurrence and tympanic membrane perforation after the tube removal or extrusion. METHODS Altogether, 447 ears from 234 pediatric patients younger than 15 years of age were studied retrospectively. All patients had undergone long-term tympanostomy ventilation tube: the Goode T-tube insertion for OME at the Osaka Women's and Children's Hospital, which is the pediatrics specialty hospital between April 2014 and March 2016. They were typically followed up every 3-4 months or more frequently if necessary due to otorrhea or tube infection. Subsequently, the tube duration, survival rates of the tube especially at 22 months after insertion defined as "full-term placement", and the rates of recurrence and perforation were calculated and statistically evaluated. RESULTS Of 447 ears, 335 ears from 184 patients underwent their first tube insertion, and 112 ears from 64 patients underwent their second or subsequent tube insertion within the targeted period. Two hundred ears from 106 patients were associated with a cleft palate. The survival rate at full-term placement was 51.7%. The recurrence rate was 56.3%, and the rate of the tympanic perforation was 8.5%. CONCLUSIONS Approximately half of the tubes survived for 22 months. The perforation rate was relatively low; however, recurrence of OME was seen in more than half the ears.
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Affiliation(s)
- Shintaro Otsuka
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otorhinolaryngology, Nara City Hospital, 1-50-1 Higashikideracho, Nara, Nara, 630-8305, Japan
| | - Ryusuke Imai
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Takefumi Kamakura
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Hiroshi Nishimura
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otolaryngology-Head and Neck Surgery, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan
| | - Yasuhiro Osaki
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otolaryngology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Masashi Furukawa
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Furukawa ENT Clinic, 5-1 Oharacho, Ashiya, Hyogo, 659-0092, Japan
| | - Toshimichi Yasui
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Yasui ENT Clinic, 1294-1 Minaminakayasumatsu, Izumisano, Osaka, 598-0033, Japan
| | - Maki Yamashita
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojimaku, Osaka, 534-0021, Japan
| | - Megumi Nakamura
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojimaku, Osaka, 534-0021, Japan
| | - Yoriko Iwamoto
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Kimi Kanazu
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Shinichi Yonei
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otolaryngology-Head and Neck Surgery, Higashiosaka City Medical Center, 3-4-5 Nishiiwata, Higashiosaka, Osaka, 578-8588, Japan
| | - Suzuyo Okazaki
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Masayuki Hirose
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
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Alaraifi AK, Alkhaldi AS, Ababtain IS, Alsaab FA. Predictors of tympanostomy tube extrusion time in otitis media with effusion. Saudi Med J 2022; 43:730-734. [PMID: 35830986 PMCID: PMC9749685 DOI: 10.15537/smj.2022.43.7.20220323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To investigate the impact and predictors of tympanostomy tube (TT) extrusion. METHODS A retrospective study on 258 ears underwent TT insertion during 2016-2018 at King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia. Patients were followed for 36-48 months postoperatively to detect the recurrence rate. The sample was divided into 2 groups based on extrusion time and were compared to determine the predictors of TT extrusion. RESULTS Otitis media with effusion (OME) recurrence after TT insertion was detected in 28.7%. A shorter TT extrusion time was associated with a higher recurrence (p=0.002). Small TTs increased the probability of early TT extrusion (odds ratio = 5.144; 95% confidence interval: [1.602-16.519]). CONCLUSION More than one-fourth of the patients who underwent TT insertion for OME developed recurrence. Tympanostomy tube extrusion earlier than 12 months was associated with a higher recurrence rate. Small TTs increased the probability of early TT extrusion.
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Affiliation(s)
- Abdulaziz K. Alaraifi
- From the Division of Otolaryngology - Head and Neck Surgery (Alaraifi, Alkhaldi, Alsaab), Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, and from College of Medicine (Ababtain), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah S. Alkhaldi
- From the Division of Otolaryngology - Head and Neck Surgery (Alaraifi, Alkhaldi, Alsaab), Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, and from College of Medicine (Ababtain), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Ibrahim S. Ababtain
- From the Division of Otolaryngology - Head and Neck Surgery (Alaraifi, Alkhaldi, Alsaab), Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, and from College of Medicine (Ababtain), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Fahad A. Alsaab
- From the Division of Otolaryngology - Head and Neck Surgery (Alaraifi, Alkhaldi, Alsaab), Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, and from College of Medicine (Ababtain), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
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8
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Nomura Y, Oshima H, Nomura K, Kakuta R, Ikeda R, Hirano AK, Ota J, Kawase T, Katori Y. Outcome of the 'waiting until spontaneous extrusion' strategy for long-term tympanostomy tube placement in children with cleft palate. Acta Otolaryngol 2022; 142:248-253. [PMID: 35451931 DOI: 10.1080/00016489.2022.2041210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Otitis media with effusion (OME) in children with cleft palate (CP) is known to be refractory to treatment and most of these patients undergo surgery for ventilation tube (VT) placement. OBJECTIVES To identify the outcomes of children with CP using long-term VT with a 'waiting until spontaneous extrusion' strategy. MATERIAL AND METHODS We retrospectively reviewed the medical records of all children with CP who visited our department from December 2016 to November 2017 and who received long-term VT placement in our department. Risk factors related to residual perforation and recurrence of OME were analyzed. RESULTS A total of 106 children were included in this study. Our statistical analysis of 94 ears followed for more than three months after VT loss revealed that longer VT placement was associated with residual perforation, and shorter VT placement was associated with OME recurrence. Although a longer duration of VT placement was associated with an increased rate, extremely long-term VT placement was not associated with residual perforation, as expected. Half of the VTs were spontaneously extruded at 40 months after insertion. CONCLUSIONS AND SIGNIFICANCE Long-term VT insertion using a waiting until spontaneous extrusion strategy is a potential option for children with CP.
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Affiliation(s)
- Yuri Nomura
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- Sen-En Rifu Otological Surgery Center, Miyagi, Japan
| | | | - Kazuhiro Nomura
- Department of Otolaryngology, Tohoku Kosai Hospital, Sendai, Japan
| | - Risako Kakuta
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology, Iwate prefectural Iwai hospital, Iwate, Japan
| | - Ai Kawamoto Hirano
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Ota
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tetsuaki Kawase
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- Laboratory of Rehabilitative Auditory Science, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Rosenfeld RM, Tunkel DE, Schwartz SR, Anne S, Bishop CE, Chelius DC, Hackell J, Hunter LL, Keppel KL, Kim AH, Kim TW, Levine JM, Maksimoski MT, Moore DJ, Preciado DA, Raol NP, Vaughan WK, Walker EA, Monjur TM. Clinical Practice Guideline: Tympanostomy Tubes in Children (Update). Otolaryngol Head Neck Surg 2022; 166:S1-S55. [PMID: 35138954 DOI: 10.1177/01945998211065662] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Insertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the United States. Tympanostomy tubes are most often inserted because of persistent middle ear fluid, frequent ear infections, or ear infections that persist after antibiotic therapy. All these conditions are encompassed by the term otitis media (middle ear inflammation). This guideline update provides evidence-based recommendations for patient selection and surgical indications for managing tympanostomy tubes in children. The guideline is intended for any clinician involved in managing children aged 6 months to 12 years with tympanostomy tubes or children being considered for tympanostomy tubes in any care setting as an intervention for otitis media of any type. The target audience includes specialists, primary care clinicians, and allied health professionals. PURPOSE The purpose of this clinical practice guideline update is to reassess and update recommendations in the prior guideline from 2013 and to provide clinicians with trustworthy, evidence-based recommendations on patient selection and surgical indications for managing tympanostomy tubes in children. In planning the content of the updated guideline, the guideline update group (GUG) affirmed and included all the original key action statements (KASs), based on external review and GUG assessment of the original recommendations. The guideline update was supplemented with new research evidence and expanded profiles that addressed quality improvement and implementation issues. The group also discussed and prioritized the need for new recommendations based on gaps in the initial guideline or new evidence that would warrant and support KASs. The GUG further sought to bring greater coherence to the guideline recommendations by displaying relationships in a new flowchart to facilitate clinical decision making. Last, knowledge gaps were identified to guide future research. METHODS In developing this update, the methods outlined in the American Academy of Otolaryngology-Head and Neck Surgery Foundation's "Clinical Practice Guideline Development Manual, Third Edition: A Quality-Driven Approach for Translating Evidence Into Action" were followed explicitly. The GUG was convened with representation from the disciplines of otolaryngology-head and neck surgery, otology, pediatrics, audiology, anesthesiology, family medicine, advanced practice nursing, speech-language pathology, and consumer advocacy. ACTION STATEMENTS The GUG made strong recommendations for the following KASs: (14) clinicians should prescribe topical antibiotic ear drops only, without oral antibiotics, for children with uncomplicated acute tympanostomy tube otorrhea; (16) the surgeon or designee should examine the ears of a child within 3 months of tympanostomy tube insertion AND should educate families regarding the need for routine, periodic follow-up to examine the ears until the tubes extrude.The GUG made recommendations for the following KASs: (1) clinicians should not perform tympanostomy tube insertion in children with a single episode of otitis media with effusion (OME) of less than 3 months' duration, from the date of onset (if known) or from the date of diagnosis (if onset is unknown); (2) clinicians should obtain a hearing evaluation if OME persists for 3 months or longer OR prior to surgery when a child becomes a candidate for tympanostomy tube insertion; (3) clinicians should offer bilateral tympanostomy tube insertion to children with bilateral OME for 3 months or longer AND documented hearing difficulties; (5) clinicians should reevaluate, at 3- to 6-month intervals, children with chronic OME who do not receive tympanostomy tubes, until the effusion is no longer present, significant hearing loss is detected, or structural abnormalities of the tympanic membrane or middle ear are suspected; (6) clinicians should not perform tympanostomy tube insertion in children with recurrent acute otitis media who do not have middle ear effusion in either ear at the time of assessment for tube candidacy; (7) clinicians should offer bilateral tympanostomy tube insertion in children with recurrent acute otitis media who have unilateral or bilateral middle ear effusion at the time of assessment for tube candidacy; (8) clinicians should determine if a child with recurrent acute otitis media or with OME of any duration is at increased risk for speech, language, or learning problems from otitis media because of baseline sensory, physical, cognitive, or behavioral factors; (10) the clinician should not place long-term tubes as initial surgery for children who meet criteria for tube insertion unless there is a specific reason based on an anticipated need for prolonged middle ear ventilation beyond that of a short-term tube; (12) in the perioperative period, clinicians should educate caregivers of children with tympanostomy tubes regarding the expected duration of tube function, recommended follow-up schedule, and detection of complications; (13) clinicians should not routinely prescribe postoperative antibiotic ear drops after tympanostomy tube placement; (15) clinicians should not encourage routine, prophylactic water precautions (use of earplugs or headbands, avoidance of swimming or water sports) for children with tympanostomy tubes.The GUG offered the following KASs as options: (4) clinicians may perform tympanostomy tube insertion in children with unilateral or bilateral OME for 3 months or longer (chronic OME) AND symptoms that are likely attributable, all or in part, to OME that include, but are not limited to, balance (vestibular) problems, poor school performance, behavioral problems, ear discomfort, or reduced quality of life; (9) clinicians may perform tympanostomy tube insertion in at-risk children with unilateral or bilateral OME that is likely to persist as reflected by a type B (flat) tympanogram or a documented effusion for 3 months or longer; (11) clinicians may perform adenoidectomy as an adjunct to tympanostomy tube insertion for children with symptoms directly related to the adenoids (adenoid infection or nasal obstruction) OR in children aged 4 years or older to potentially reduce future incidence of recurrent otitis media or the need for repeat tube insertion.
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Affiliation(s)
| | - David E Tunkel
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Charles E Bishop
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Daniel C Chelius
- Baylor College of Medicine-Texas Children's Hospital, Houston, Texas, USA
| | - Jesse Hackell
- Pomona Pediatrics, Boston Children's Health Physicians, Pomona, New York, USA.,New York Medical College, Valhalla, New York, USA
| | - Lisa L Hunter
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Ana H Kim
- Columbia University Medical Center, New York, New York, USA
| | - Tae W Kim
- University of Minnesota School of Medicine/Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Jack M Levine
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | | | - Denee J Moore
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | | | - William K Vaughan
- Consumers United for Evidence-Based Healthcare, Falls Church, Virginia, USA
| | | | - Taskin M Monjur
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Becks A, Teh BM, Lalwani AK. When Should a Retained Tympanostomy Tube be Removed? Laryngoscope 2021; 132:1505-1507. [PMID: 34821389 DOI: 10.1002/lary.29952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/14/2021] [Accepted: 11/10/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Alahni Becks
- Morehouse School of Medicine, Atlanta, Georgia, U.S.A
| | - Bing M Teh
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Anil K Lalwani
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A.,Department of Mechanical Engineering, The Fu Foundation School of Engineering and Applied Science, Columbia University, New York, New York, U.S.A
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11
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Lin YC, Kao YL, Chen YC, Chen LC, Dang LH, Hung SH. Factors Related to Ventilation Tube Extrusion Time in Children and Adults. EAR, NOSE & THROAT JOURNAL 2021; 102:NP169-NP176. [PMID: 33720800 DOI: 10.1177/0145561321999204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to investigate the factors affecting extrusion time in both children and adults with ventilation tube (VT) insertion, providing useful information for clinicians for better decision-making, follow strategy, and potentially improve clinical outcomes for these patients. METHODS Data from patients receiving myringotomy with VT insertion from January 1, 2007, to June 30, 2012, were retrospectively collected and analyzed by the end of 2018. Various factors, including age, gender, history of VT insertion, tympanogram, size of VT used, local finding of tympanic membrane, hypertension, diabetes mellitus, hyperlipidemia, and postoperative ear infection, were included and analyzed to examine the effects of these factors on extrusion time. RESULTS A total of 447 patients were included in this study (Child group-Adult group = 237:210). The overall average extrusion time was 225.85 days. In the subgroup analysis, the average time was 221.3 days and 231.0 days for children and adults, respectively. The results showed that the VT extrusion time was significantly longer in participants without a history of VT insertion and in those where larger sized VTs were inserted in both age-groups. Male gender had an influence on extrusion time in children. In addition, a history of VT insertion and VT size were determined to be factors related to extrusion before 12 months in children. CONCLUSION History of VT insertion and VT size were significantly related to VT extrusion time in both children and adults and defined as factors associated with extrusion before 12 months in children. The findings suggest avoiding VT with a diameter < 1 mm and considering an appropriately larger size in patients with a history of VT insertion to optimize VT retention.
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Affiliation(s)
- Yi-Chih Lin
- Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, Taipei
| | - Yi-Lin Kao
- Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei
| | - Yen-Chun Chen
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei
| | - Lung-Che Chen
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei
| | - Luong Huu Dang
- Department of Otolaryngology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Shih-Han Hung
- Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei.,International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei.,Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei
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Shay EO, Shah J, Smith B, Anne S. Impact of perforation size and predictive factors for successful pediatric gelfoam myringoplasty. Am J Otolaryngol 2020; 41:102317. [PMID: 31732314 DOI: 10.1016/j.amjoto.2019.102317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/11/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Rates of success with pediatric myringoplasty range from 35 to 95%. The objective of this study is to evaluate the impact of perforation size on successful closure of the tympanic membrane (TM) after gelfoam myringoplasty. We also aim to identify variables that affect perforation closure rates and define predictive factors for successful TM closure. METHODS A retrospective chart review of all patients that underwent gelfoam myringoplasty by a single surgeon from August 2008 through January 2015 was performed. RESULTS One hundred fifty-nine patients met inclusion criteria and underwent a total of 219 procedures. Overall, gelfoam myringoplasty had an 83.1% rate of successful closure. Average perforation size was 15.31%. Classification tree analysis separated our cohort into three groups based on perforation size: Group 1 (<16.25%) had a 91% closure rate, group 2 (16.25% to <31.25%) had a 66.0% closure rate and group 3 (≥31.25%) had a 30.0% closure rate. Smaller perforations (P ≤0.001) were associated with increased success rates. Other factors associated with successful closure of the TM included younger age at the time of myringoplasty (P ≤0.001), fewer number of prior tympanostomy tubes (P = 0.016), and lesser duration of tube retention (P = 0.003). CONCLUSION Gelfoam myringoplasty provides good overall TM closure rates and may be considered as a potential first-line option for repair of perforations, including those involving up to 40% of the TM. Younger patients with smaller perforations, fewer sets of tubes, shorter length of tube retention are more likely to have successful closure of the tympanic membrane.
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Affiliation(s)
- Elizabeth O Shay
- Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue NA21, Cleveland, OH 44195, United States of America
| | - Janki Shah
- Cleveland Clinic, Head and Neck Institute, 9500 Euclid Avenue A71, Cleveland, OH 44195, United States of America
| | - Blake Smith
- Cleveland Clinic, Head and Neck Institute, 9500 Euclid Avenue A71, Cleveland, OH 44195, United States of America
| | - Samantha Anne
- Cleveland Clinic, Head and Neck Institute, 9500 Euclid Avenue A71, Cleveland, OH 44195, United States of America.
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