From the Guidelines
Complications of ear tympanostomy, such as acute tube otorrhea (TTO), persistent tympanic membrane perforation, and cholesteatoma, can occur in up to 50% of children, emphasizing the need for careful management and follow-up. The most common complications include:
- Acute TTO, which occurs in up to 50% of children, can be managed with topical antibiotic ear drops and does not usually require oral antibiotics 1
- Persistent tympanic membrane perforation, which occurs in about 2% of short-term tubes and up to 20% of long-term tubes 1
- Cholesteatoma, which is a rare but serious complication, occurring in about 0.5% of ears 1
- Tube blockage or failure to extrude, which can occur in up to 3% of cases 1 It is essential to educate caregivers about these potential complications and their management, including the use of water precautions during episodes of acute TTO or recurrent infections 1. Regular follow-up every 6 months is crucial to monitor tube function and detect complications early, allowing for prompt intervention and minimizing the risk of long-term sequelae 1.
From the Research
Ear Tympanostomy Complications
- Otorrhea is a common complication of tympanostomy tubes, occurring in 21 to 50% of all children with tympanostomy tubes in the United States 2
- The organisms typically responsible for otorrhea are the same as those that cause otitis media in very young children, including Streptococcus pneumonia, Haemophilus influenzae and Moraxella catarrhalis 2
- In older children, drainage from tympanostomy tubes involves organisms that colonize the external auditory canal, the most common being Pseudomonas aeruginosa and Staphylococcus aureus 2
Treatment of Otorrhea
- Ofloxacin, a newer fluoroquinalone antibiotic, has several advantages over other agents available for the treatment of otorrhea caused by acute otitis media in patients with tympanostomy tubes 2
- Ciprofloxacin plus fluocinolone is more effective than treatment with ciprofloxacin or fluocinolone alone for acute otitis media with tympanostomy tubes (AOMT) 3
- The combination of ciprofloxacin plus fluocinolone is safe and well tolerated in children 3
Prevention of Postoperative Otorrhea
- Topical ciprofloxacin application after tympanostomy tube insertion is associated with a significantly lower incidence of early posttympanostomy otorrhea 4
- There is no significant difference in the rate of postoperative otorrhea when choosing between oxymetazoline, ofloxacin, or ciprofloxacin/dexamethasone drops for use in the postoperative period after tympanostomy tube placement 5
- Prior placement of tubes is significantly correlated to postoperative otorrhea 5