Tympanostomy tube obstruction linked with delayed follow-up, serous fluid

By Will Boggs MD

NEW YORK (Reuters Health) - The presence of serous fluid, and delayed follow-up after placement, are associated with an increased risk of postoperative tympanostomy tube obstruction, according to a retrospective medical record review.

"Putting in ear tubes is not a one and done visit," said Dr. Udayan K. Shah from Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware.

"Follow up - preferably within two weeks of surgery - is critical to ensure early identification of a clogged tube, which can be seen in up to 20% of kids depending on what type of ear fluid there is," Dr. Shah told Reuters Health. "Catching this problem early can permit quick management to ensure the children benefit from their tympanostomy tubes."

Tube clogging may require office procedures, medication trials, and possibly tube replacement under another general anesthetic, so surgeons often employ a variety of therapies intended to prevent tube obstruction.

In an effort to identify predictors of tube obstruction, Dr. Shah and colleagues reviewed the medical records of 248 patients who underwent bilateral myringotomy and tympanostomy tube placement between 2007 and 2011.

During follow-up, 36 patients (10.6%) experienced obstruction of one or both tympanostomy tubes, according to the July 10th JAMA Otolaryngology Head and Neck Surgery online report.

Patients who had any type of fluid in the middle ear at the time of surgery were 2.6 times more likely than patients without fluid to experience tube occlusion, and patients with serous fluid had the highest rate of tube blockage (20%).

Patients with mucoid fluid (the most common effusion) had clogging rates similar to those for children without any ear fluid.

Children younger than two years were more likely than older children to have clogged tubes at first follow-up and to require an extra set of tubes.

The more time that passed between surgery and the first follow-up, the more likely the patient was to have a clogged tube, with each day increase in time increasing the odds of obstruction by 1%.

"We theorize that this is due to a higher likelihood of debris building up or, for example, intercurrent middle ear fluid from upper respiratory infections occluding the lumen," the researchers say.

"Early identification of occlusion will permit for prompt management and preservation of the important function of tympanostomy tubes," Dr. Shah said.

Besides follow-up within the first two weeks after surgery, Dr. Shah recommended "ear drops for a week: whether they contain an antibiotic alone or also have a steroid component remains to be studied."

SOURCE: http://bit.ly/1mSavkR

JAMA Otolaryngol Head Neck Surg 2014.

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