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Original Investigation |

Risk Factors Associated With Postoperative Tympanostomy Tube Obstruction

David E. Conrad, MD1,2; Jessica R. Levi, MD3; Zachary A. Theroux, BSBA1; Yell Inverso, PhD, AuD1; Udayan K. Shah, MD1,2,4
[+] Author Affiliations
1Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
2Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
3Department of Otolaryngology, Boston University Hospital, Boston, Massachusetts
4Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania
JAMA Otolaryngol Head Neck Surg. 2014;140(8):727-730. doi:10.1001/jamaoto.2014.1176.
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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.

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