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Risk Factors Associated With Postoperative Tympanostomy Tube Obstruction.
Conrad, David E. MD 1,2; Levi, Jessica R. MD 3; Theroux, Zachary A. BSBA 1; Inverso, Yell PhD, AuD 1; Shah, Udayan K. MD 1,2,4
[Miscellaneous] JAMA Otolaryngology-Head & Neck Surgery. 140(8):727-730, August 2014.

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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.