OTITIS MEDIA WITH EFFUSION: RECURRENCE AFTER TYMPANOSTOMY TUBE EXTRUSION
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Keywords
Otitis Media, Middle Ear Effusion, Tympanostomy Tube Extrusion, Recurrence
Abstract
Objective: Investigations were conducted on the prevalence of recurrent otitis media with effusion (OME) among kids following tympanostomy tube extrusion, as well as the association among relapse and tube retention period. The association among the recurrence rate and the tube insertion age at the beginning was investigated as well.
Methods: Ninety-one children (169 ears) in a retrospective study involving individuals who underwent tympanostomy tube insertion were examined. Children's ears were separated into three categories based on how long their tympanostomy tubes remained in place. Category A: fewer than six months of tympanostomy tube retention. Category B: six to twelve months of tympanostomy tube retention. Category C: retention period of tympanostomy tubes for a year or longer
Results: A study involving 168 ears from 90 children (39.6% female, 58.2% male) was conducted to evaluate the outcomes of tympanostomy tube insertion. The mean age for the first tube implantation was 8.43±2.25 years, with a monitoring period ranging from 7 to 77 months (median 24.43±15.69 months). The average tube retention period was 9.76±5.44 months. In 93.41% of cases, adenotonsillectomy or adenoidectomy was performed alongside tube insertion. Post-extrusion, recurrent otitis media with effusion (OME) occurred in 21% of ears. Recurrence rates varied by extrusion time: <6 months (37.45%), 7-13 months (18.47%), and ≥13 months (10.01%), with significant differences between the groups (p = 0.03, p = 0.0023). Gender-specific recurrence rates were 10.1% for males and 12% for females, showing no significant difference (p = 0.398). Age group analysis revealed no significant difference in recurrence between preschoolers (4.4%) and school-age children (16.3%) (p = 0.237).
Conclusion: Following tympanostomy tube the extrusion process children should have routine follow-ups to ensure that OME doesn't reoccur. The recurrence rate increased with the length of the tympanostomy tube retention period. The tubes that have the smallest likelihood of complications and recurring are the best choice for treating OME. To determine the correlation between the occurrence of OME and the ideal period of tube stay in the tympanic membrane, more research is required. As a result, additional research including bigger series is required to examine the relationship between various tympanostomy tubes and recurrence rates following tube extrusion.
References
2. Altıntaş M, Bayar Muluk N, Peng KA. What Is the Significance of Rhinitis in Otitis Media with Effusion?. Challenges in Rhinology. 2021:159-68.
3. Brown TH. Childhood hearing impairment. Paediatrics and Child health. 2020 Jan 1;30(1):6-13.
4. Feng Y, Meng YP, Dong YY, Qiu CY, Cheng L. Management of allergic rhinitis with leukotriene receptor antagonists versus selective H1-antihistamines: a meta-analysis of current evidence. Allergy, Asthma & Clinical Immunology. 2021 Dec;17:1-2.
5. Satoh C, Toizumi M, Nguyen HA, Hara M, Bui MX, Iwasaki C, Takegata M, Kitamura N, Suzuki M, Hashizume M, Dang DA. Prevalence and characteristics of children with otitis media with effusion in Vietnam. Vaccine. 2021 May 6;39(19):2613-9.
6. Al-Salim S, Tempero RM, Johnson H, Merchant GR. Audiologic profiles of children with otitis media with effusion. Ear and hearing. 2021 Sep 1;42(5):1195-207.
7. Arumugam K. Managing paediatric otitis media with effusion: systematic review. Int J Acad Med Pharm. 2023;5(4):1131-5.
8. Rosenfeld RM, Tunkel DE, Schwartz SR, Anne S, Bishop CE, Chelius DC, Hackell J, Hunter LL, Keppel KL, Kim AH, Kim TW. Clinical practice guideline: tympanostomy tubes in children (update). Otolaryngology–Head and Neck Surgery. 2022 Feb;166:S1-55.
9. Nagar RR, Deshmukh PT. An overview of the tympanostomy tube. Cureus. 2022 Oct;14(10).
10. Al Sheeyab HA, Belkhair HA, Assanousi AA. Complications of ventilation tube insertion in otitis media with effusion.
11. Sanudin SH, Hashim ND, Abdullah A. Clinical Review of Myringotomy and Tympanostomy Tube Insertion among Pediatric Patients at Ukm Medical Centre. International Medical Journal. 2020 Jun 1;27(3).
12. Pauna HF, Monsanto RC, Oyama LA, Chornobay AP, Salvi K, Sassaki LT, Paparella MM. Post-Tympanostomy Tube Otorrhea and Other Complications. InTextbook of Otitis Media: The Basics and Beyond 2023 Dec 30 (pp. 223-231). Cham: Springer International Publishing.
13. Stanton E, Kondra K, Brahme I, Lasky S, Munabi NC, Jimenez C, Jacob L, Urata MM, Hammoudeh JA, Magee III WP. Tympanostomy Tubes: Are They Necessary? A Systematic Review on Implementation in Cleft Care. The Cleft Palate Craniofacial Journal. 2023 Apr;60(4):430-45.
14. de Sousa FA, Castro AD, Machado AS, Pinto AN, Coutinho MB, e Sousa CA. Anthropometry: A clue for Otorhinolaryngology surgical indications in children. International Journal of Pediatric Otorhinolaryngology. 2020 Dec 1;139:110421.
15. Hancock S, Allen P, Faria J, Vandjelovic N, Benoit MM. Adenoidectomy may decrease the need for a third set of tympanostomy tubes in children. International Journal of Pediatric Otorhinolaryngology. 2022 Jun 1;157:111130.
16. Goel AN, Omorogbe A, Hackett A, Rothschild MA, Londino III AV. Risk factors for multiple tympanostomy tube placements in children: systematic review and meta‐analysis. The Laryngoscope. 2021 Jul;131(7):E2363-70.
17. El Begermy MA, El Begermy MM, Kassamy H. The effect of endoscopic peritubal adenoidectomy vs myringotomy with ventilation tubes insertion in management of otitis media with effusion in children. Egyptian Journal of Ear, Nose, Throat and Allied Sciences. 2022 Jan 1;23(23):1-0.
18. Rosenfeld RM, Tunkel DE, Schwartz SR, Anne S, Bishop CE, Chelius DC, Hackell J, Hunter LL, Keppel KL, Kim AH, Kim TW. Clinical practice guideline: tympanostomy tubes in children (update). Otolaryngology–Head and Neck Surgery. 2022 Feb;166:S1-55.
19. Valtonen HJ, Qvarnberg YH, Nuutinen J. Otological and audiological outcomes five years after tympanostomy in early childhood. The Laryngoscope. 2002 Apr;112(4):669-75.
20. Kalcioglu MT, Cokkeser Y, Kizilay A, Ozturan O. Follow-up of 366 ears after tympanostomy tube insertion: why is it draining?. Otolaryngology—Head and Neck Surgery. 2003 Apr;128(4):560-4.
21. Shareef A, Langenfeld T, Hill M, Vachhrajani S, Elluru R. Efficacy of tympanostomy tube placement with adjuvant adenoidectomy in children less than 4 years of age. International Journal of Pediatric Otorhinolaryngology. 2024 Jan 1;176:111823.
22. Otsuka S, Imai R, Kamakura T, Nishimura H, Osaki Y, Furukawa M, Yasui T, Yamashita M, Nakamura M, Iwamoto Y, Kanazu K. How long do tympanostomy ventilation tubes last in pediatric patients with otitis media with effusion or adhesion? A study using Kaplan-Meier survival analysis. International Journal of Pediatric Otorhinolaryngology. 2022 Aug 1;159:111210.
23. Riad HA, Shady EF, Elnems MG, Ahmed RM, Eldsouky SM. Early Extrusion of Grommet Tubes and its Impact on Eustachian Tubes of Children. The Egyptian Journal of Hospital Medicine (January 2024). 2024 Jan 1;94:42-6.
24. Norhafizah S, Salina H, Goh BS. Prevalence of allergic rhinitis in children with otitis media with effusion. Eur Ann Allergy Clin Immunol. 2020 May 5;52(3):121-30.
25. Yaman H, Yilmaz S, Guclu E, Subasi B, Alkan N, Ozturk O. Otitis media with effusion: recurrence after tympanostomy tube extrusion. International journal of pediatric otorhinolaryngology. 2010 Mar 1;74(3):271-4.
26. Ferlito S, Cocuzza S, Grillo C, La Mantia I, Gulino A, Galletti B, Coco S, Renna C, Cipolla F, Di Luca M, Maniaci A. Complications and sequelae following tympanostomy tube placement in children with effusion otitis media: Single center experience and review of literature. Acta Medica Mediterranea. 2020 Jan 1;36(3):1905-12.
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Dr Ijaz Ahmad
Specialist Registrar, Hayatabad Medical Complex, Peshawar Pakistan
Dr Sahibzada Fakhre Alam
ENT Consultant, DHQ Hospital, Charsadda Pakistan
Dr Jawad Badshah
ENT Specialist, Shifa International Hospital, Islamabad Pakistan
Dr Hamid Mukhtar
Senior Registrar ENT, Northwest General Hospital and Research Center, Peshawar Pakistan