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Risk factors associated with postoperative tympanostomy tube obstruction.
JAMA Otolaryngol Head Neck Surg 2014; 140(8):727-30JO

Abstract

IMPORTANCE

Myringotomy and tympanostomy tube placement for chronic otitis media with effusion is the most common reason for a child to undergo anesthesia in the United States. Postoperative tube obstruction occurs in 1.4% to 36.0% of cases and remains a challenge in achieving middle ear ventilation.

OBJECTIVE

To identify risk factors associated with tube obstruction.

DESIGN, SETTING, AND PARTICIPANTS

Retrospective medical record review of 248 patients, mean age 2.54 years, seen between March 2007 and June 2011 in a tertiary care pediatric hospital.

INTERVENTIONS

Tympanostomy tube placement and postoperative otic drop therapy.

MAIN OUTCOMES AND MEASURES

Tube patency at postoperative visit, number of tube removals and revisions, age, sex, body mass index (BMI), middle ear fluid type at time of surgery, and time between surgery and first postoperative visit were examined. Type of surgery (tympanostomy tube placement alone, adenoidectomy + tympanostomy tube placement, tympanostomy tube placement + adenoidectomy + tonsillectomy) and its effect on tube patency were also reviewed.

RESULTS

At first follow-up, 10.6% of patients had occlusion of one or both tubes. No significant association was found between tube patency and a patient's BMI percentile, sex, or procedure type. Patients with no middle ear fluid were more likely to have patent tubes than those who had serous fluid (odds ratio [OR], 3.5; 95% CI, 1.2-10.6; P = .02). A significant inverse correlation was found between patency and time between surgery and follow-up in that patients who had longer follow-up after surgery were less likely to have patent tubes (OR per day of follow-up delay, 0.990; 95% CI, 0.981-0.999; P = .01).

CONCLUSIONS AND RELEVANCE

Tympanostomy tube obstruction was seen in 10.6% of patients. Serous fluid and increased time to postoperative visit were statistically significant indicators for tube occlusion.

Authors+Show Affiliations

Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware2Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.Department of Otolaryngology, Boston University Hospital, Boston, Massachusetts.Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware.Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware.Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware2Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania4Department of Pediatrics, Thomas Jeffers.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25009981

Citation

Conrad, David E., et al. "Risk Factors Associated With Postoperative Tympanostomy Tube Obstruction." JAMA Otolaryngology-- Head & Neck Surgery, vol. 140, no. 8, 2014, pp. 727-30.
Conrad DE, Levi JR, Theroux ZA, et al. Risk factors associated with postoperative tympanostomy tube obstruction. JAMA Otolaryngol Head Neck Surg. 2014;140(8):727-30.
Conrad, D. E., Levi, J. R., Theroux, Z. A., Inverso, Y., & Shah, U. K. (2014). Risk factors associated with postoperative tympanostomy tube obstruction. JAMA Otolaryngology-- Head & Neck Surgery, 140(8), pp. 727-30. doi:10.1001/jamaoto.2014.1176.
Conrad DE, et al. Risk Factors Associated With Postoperative Tympanostomy Tube Obstruction. JAMA Otolaryngol Head Neck Surg. 2014;140(8):727-30. PubMed PMID: 25009981.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors associated with postoperative tympanostomy tube obstruction. AU - Conrad,David E, AU - Levi,Jessica R, AU - Theroux,Zachary A, AU - Inverso,Yell, AU - Shah,Udayan K, PY - 2014/7/11/entrez PY - 2014/7/11/pubmed PY - 2014/10/22/medline SP - 727 EP - 30 JF - JAMA otolaryngology-- head & neck surgery JO - JAMA Otolaryngol Head Neck Surg VL - 140 IS - 8 N2 - IMPORTANCE: Myringotomy and tympanostomy tube placement for chronic otitis media with effusion is the most common reason for a child to undergo anesthesia in the United States. Postoperative tube obstruction occurs in 1.4% to 36.0% of cases and remains a challenge in achieving middle ear ventilation. OBJECTIVE: To identify risk factors associated with tube obstruction. DESIGN, SETTING, AND PARTICIPANTS: Retrospective medical record review of 248 patients, mean age 2.54 years, seen between March 2007 and June 2011 in a tertiary care pediatric hospital. INTERVENTIONS: Tympanostomy tube placement and postoperative otic drop therapy. MAIN OUTCOMES AND MEASURES: Tube patency at postoperative visit, number of tube removals and revisions, age, sex, body mass index (BMI), middle ear fluid type at time of surgery, and time between surgery and first postoperative visit were examined. Type of surgery (tympanostomy tube placement alone, adenoidectomy + tympanostomy tube placement, tympanostomy tube placement + adenoidectomy + tonsillectomy) and its effect on tube patency were also reviewed. RESULTS: At first follow-up, 10.6% of patients had occlusion of one or both tubes. No significant association was found between tube patency and a patient's BMI percentile, sex, or procedure type. Patients with no middle ear fluid were more likely to have patent tubes than those who had serous fluid (odds ratio [OR], 3.5; 95% CI, 1.2-10.6; P = .02). A significant inverse correlation was found between patency and time between surgery and follow-up in that patients who had longer follow-up after surgery were less likely to have patent tubes (OR per day of follow-up delay, 0.990; 95% CI, 0.981-0.999; P = .01). CONCLUSIONS AND RELEVANCE: Tympanostomy tube obstruction was seen in 10.6% of patients. Serous fluid and increased time to postoperative visit were statistically significant indicators for tube occlusion. SN - 2168-619X UR - https://www.unboundmedicine.com/medline/citation/25009981/Risk_factors_associated_with_postoperative_tympanostomy_tube_obstruction_ L2 - https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/10.1001/jamaoto.2014.1176 DB - PRIME DP - Unbound Medicine ER -