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Often when children experience middle ear infections followed by persistent middle-ear effusion (MEE) the doctor recommends myringotomy (creation of a hole in the eardrum) and tympanostomy-tube placement (TTP) to drain the liquid from the ear and to maintain middle-ear ventilation in order to prevent reinfection and hearing problems. In fact, TTP is the most commonly performed surgery among U.S. children beyond the newborn period. However, tube otorrhea (discharge of pus through the tube) is a common and often recurring complication in young children who have undergone tube placement for persistent MEE, concludes this study which was jointly funded by the Agency for Healthcare Research and Quality and the National Institute for Child Health and Human Development (HD26026).
The investigators, who were led by Jack L. Paradise, M.D., of the University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, prospectively monitored the middle ear status of
173 children who underwent bilateral TTP between 6 and 36 months of age. They treated episodes of tube otorrhea with oral antibiotics and, if persistent, with topical medication applied in the ear.
During the first 18 months after TTP, the proportion of children who developed one or more episodes of otorrhea increased progressively, reaching 75 percent after 12 months and 83 percent after 18 months. The mean number of episodes per child was 0.79 in the first 6 months, 1.50 in the first 12 months, 2.17 in the first 18 months, and 2.82 in the first 24 months. Overall, otorrhea occurred earlier and was most prevalent among urban children and occurred latest and was least prevalent among suburban children. The rate of otorrhea occurrence was found to be inversely related to maternal socioeconomic status, i.e., the extent of the problem was greatest in children whose SES was lowest and least in children whose SES was highest.
Episodes of tube otorrhea lasted a mean of 16 days, with 13 percent of episodes lasting more than a month. Also, 3.5 percent of children experienced one or more episodes that failed to improve satisfactorily with conventional outpatient management. Five of these children were hospitalized to receive parenteral antibiotic treatment, one child twice and one child three times, and one child also underwent tube removal. Doctors should inform parents of children who are being considered for TTP that, in addition to other potential complications and sequelae of the procedure—such as tympanic membrane perforation, atrophy, and tympanosclerosis—tube otorrhea is a frequent complication, caution the authors.
For details, see "Otorrhea in young children after tympanostomy-tube placement for persistent middle-ear effusion: Prevalence, incidence, and duration." by Collette Ah-Tye, M.D., Dr. Paradise, and D. Kathleen Colborn, B.S., in the June 2001 Pediatrics 107(6), pp. 1251-1258.
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