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Overview of tympanostomy tube placement, postoperative care, and complications in children

Author
Glenn C Isaacson, MD, FAAP
Section Editor
Anna H Messner, MD
Deputy Editor
Carrie Armsby, MD, MPH

INTRODUCTION

Tympanostomy tube insertion is among the most common operative procedures in childhood [1,2]. As such, tympanostomy tube surgery has considerable impact on the health of young children and upon medical economics.

An overview of tympanostomy tubes, the postoperative care of the child with tympanostomy tubes, and the diagnosis and management of complications of tympanostomy tubes in children are reviewed here. The indications for, and efficacy of, tympanostomy tubes in children with otitis media with effusion (OME) and recurrent acute otitis media (AOM) are discussed separately. The prevention and management of tympanostomy tube otorrhea is also reviewed in detail separately. (See "Otitis media with effusion (serous otitis media) in children: Clinical features and diagnosis" and "Acute otitis media in children: Prevention of recurrence" and "Tympanostomy tube otorrhea in children: Causes, prevention, and management" and "Otitis media with effusion (serous otitis media) in children: Management".)

EPIDEMIOLOGY

In the United States in 2006, 667,000 children less than 15 years of age underwent surgery for insertion of tympanostomy tubes [1]. Tympanostomy tube insertion rates are high in other developed countries as well. In Denmark, approximately 30 percent of children undergo at least one ventilation tube insertion by their fifth birthday [3].

The rate of tympanostomy tube placement is higher in children who attend daycare. Children with autism spectrum disorder and/or developmental delay also undergo tube insertion at a higher rate, possibly because of a lower threshold to perform the surgery in children at greater risk for speech delay or protracted ear difficulties [4]. In addition, children with craniofacial anomalies, such as cleft palate or trisomy 21, are more likely to have dysfunction of the eustachian tube leading to the development of otitis media, with a subsequent increased risk for tympanostomy tube placement [5]. (See "Autism spectrum disorder: Clinical features", section on 'Language impairment' and "Eustachian tube dysfunction".)

The frequency of tympanostomy tube insertion in young children in the United States has declined since the introduction of the pneumococcal conjugate vaccine into the routine childhood immunization schedule in 2000. (See "Acute otitis media in children: Prevention of recurrence", section on 'Pneumococcal conjugate vaccine'.)

                           

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Literature review current through: Jul 2017. | This topic last updated: Jul 21, 2015.
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References
Top
  1. Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. Natl Health Stat Report 2009; :1.
  2. Rosenfeld RM, Schwartz SR, Pynnonen MA, et al. Clinical practice guideline: Tympanostomy tubes in children. Otolaryngol Head Neck Surg 2013; 149:S1.
  3. Djurhuus BD, Skytthe A, Christensen K, Faber CE. Increasing rate of middle ear ventilation tube insertion in children in Denmark. Int J Pediatr Otorhinolaryngol 2014; 78:1541.
  4. Ackerman S, Reilly B, Bernier R. Tympanostomy tube placement in children with autism. J Dev Behav Pediatr 2012; 33:252.
  5. Sarasoja I, Jokinen J, Lahdenkari M, et al. Long-term effect of pneumococcal conjugate vaccines on tympanostomy tube placements. Pediatr Infect Dis J 2013; 32:517.
  6. Bluestone CD, Paradise JL, Beery QC. Physiology of the eustachian tube in the pathogenesis and management of middle ear effusions. Laryngoscope 1972; 82:1654.
  7. Berger G. Nature of spontaneous tympanic membrane perforation in acute otitis media in children. J Laryngol Otol 1989; 103:1150.
  8. Alberti PW. Myringotomy and ventilating tubes in the 19th century. Laryngoscope 1974; 84:805.
  9. ARMSTRONG BW. A new treatment for chronic secretory otitis media. AMA Arch Otolaryngol 1954; 59:653.
  10. Mandel EM, Swarts JD, Casselbrant ML, et al. Eustachian tube function as a predictor of the recurrence of middle ear effusion in children. Laryngoscope 2013; 123:2285.
  11. Rosenfeld RM, Schwartz SR, Pynnonen MA, et al. Clinical practice guideline: tympanostomy tubes in children--executive summary. Otolaryngol Head Neck Surg 2013; 149:8.
  12. Browning GG, Rovers MM, Williamson I, et al. Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev 2010; :CD001801.
  13. Principi N, Marchisio P, Massironi E, et al. Prophylaxis of recurrent acute otitis media and middle-ear effusion. Comparison of amoxicillin with sulfamethoxazole and trimethoprim. Am J Dis Child 1989; 143:1414.
  14. Varsano I, Volovitz B, Mimouni F. Sulfisoxazole prophylaxis of middle ear effusion and recurrent acute otitis media. Am J Dis Child 1985; 139:632.
  15. Rosenfeld RM, Culpepper L, Doyle KJ, et al. Clinical practice guideline: Otitis media with effusion. Otolaryngol Head Neck Surg 2004; 130:S95.
  16. Klockars T, Rautio J. Early placement of ventilation tubes in cleft lip and palate patients: does palatal closure affect tube occlusion and short-term outcome? Int J Pediatr Otorhinolaryngol 2012; 76:1481.
  17. Weigel MT, Parker MY, Goldsmith MM, et al. A prospective randomized study of four commonly used tympanostomy tubes. Laryngoscope 1989; 99:252.
  18. Hussain SS. Extrusion rate of Shah and Shepard ventilation tubes in children. Ear Nose Throat J 1992; 71:273.
  19. Moore PJ. Ventilation tube duration versus design. Ann Otol Rhinol Laryngol 1990; 99:722.
  20. Saliba I, Boutin T, Arcand P, et al. Advantages of subannular tube vs repetitive transtympanic tube technique. Arch Otolaryngol Head Neck Surg 2011; 137:1210.
  21. von Schoenberg M, Wengraf CL, Gleeson M. Results of middle ear ventilation with Goode's tubes. Clin Otolaryngol Allied Sci 1989; 14:503.
  22. Goode RL. Long-term middle ear ventilation with T tubes: the perforation problem. Otolaryngol Head Neck Surg 1996; 115:500.
  23. Leopold DA, McCabe BF. Factors influencing tympanostomy tube function and extrusion: a study of 1,127 ears. Otolaryngol Head Neck Surg 1980; 88:447.
  24. Soderberg O, Hellstrom SO. Effects of different tympanostomy tubes (Teflon and stainless steel) on the tympanic membrane structures. In: Recent advances in otitis media, Lim DJ, Bluestone CD, Klein JO, Nelson JD (Eds), BC Decker Inc, Toronto 1988. p.280.
  25. Hong P, Smith N, Johnson LB, Corsten G. A randomized double-blind controlled trial of phosphorylcholine-coated tympanostomy tube versus standard tympanostomy tube in children with recurrent acute and chronic otitis media. Laryngoscope 2011; 121:214.
  26. Antonelli PJ, Sampson EM, Ojano-Dirain C. Biofilm formation on silicone tympanostomy tubes with polyvinylpyrrolidone coating. Arch Otolaryngol Head Neck Surg 2011; 137:19.
  27. Akbulut S, Altintaş H, Berk D, et al. Everolimus-coated tympanostomy tube on rat tympanic membrane. Int J Pediatr Otorhinolaryngol 2013; 77:1147.
  28. Park AH, Hoyt D, Britt D, et al. Cross-linked hydrogel and polyester resorbable ventilation tubes in a Chinchilla model. Laryngoscope 2013; 123:1043.
  29. Ojano-Dirain CP, Silva RC, Antonelli PJ. Biofilm formation on coated silicone tympanostomy tubes. Int J Pediatr Otorhinolaryngol 2013; 77:223.
  30. Jang CH, Cho YB, Choi CH. Effect of ion-bombarded silicone tympanostomy tube on ciprofloxacin-resistant Pseudomonas aeruginosa biofilm formation. Int J Pediatr Otorhinolaryngol 2012; 76:1471.
  31. Labib ME, Brumlik CJ, Stoodley P, et al. The Long-term Release of Antibiotics From Monolithic Nonporous Polymer Implants for Use as Tympanostomy Tubes. Colloids Surf A Physicochem Eng Asp 2010; 254:331.
  32. Jang CH, Park H, Cho YB, Choi CH. Effect of vancomycin-coated tympanostomy tubes on methicillin-resistant Staphylococcus aureus biofilm formation: in vitro study. J Laryngol Otol 2010; 124:594.
  33. Gourin CG, Hubbell RN. Otorrhea after insertion of silver oxide-impregnated silastic tympanostomy tubes. Arch Otolaryngol Head Neck Surg 1999; 125:446.
  34. Saidi IS, Biedlingmaier JF, Whelan P. In vivo resistance to bacterial biofilm formation on tympanostomy tubes as a function of tube material. Otolaryngol Head Neck Surg 1999; 120:621.
  35. Berry JA, Biedlingmaier JF, Whelan PJ. In vitro resistance to bacterial biofilm formation on coated fluoroplastic tympanostomy tubes. Otolaryngol Head Neck Surg 2000; 123:246.
  36. Wang JC, Tran PL, Hanes R, et al. Inhibition of otopathogenic biofilms by organoselenium-coated tympanostomy tubes. JAMA Otolaryngol Head Neck Surg 2013; 139:1009.
  37. Kivekäs I, Poe D. Is there an optimal location for tympanostomy tube placement? Laryngoscope 2015; 125:1513.
  38. April MM, Portella RR, Orobello PW Jr, Naclerio RM. Tympanostomy tube insertion: anterosuperior vs. anteroinferior quadrant. Otolaryngol Head Neck Surg 1992; 106:241.
  39. Hern JD, Jonathan DA. Insertion of ventilation tubes: does the site matter? Clin Otolaryngol Allied Sci 1999; 24:424.
  40. van Baarle PW, Wentges RT. Extrusion of transtympanic ventilating tubes, relative to the site of insertion. ORL J Otorhinolaryngol Relat Spec 1975; 37:35.
  41. Jahn AF. Middle ear ventilation with HydroxylVent tube: review of the initial series. Otolaryngol Head Neck Surg 1993; 108:701.
  42. Follow-up management of children with tympanostomy tubes. Pediatrics 2002; 109:328.
  43. Isaacson G, Rosenfeld RM. Care of the child with tympanostomy tubes: a visual guide for the pediatrician. Pediatrics 1994; 93:924.
  44. Derkay CS, Carron JD, Wiatrak BJ, et al. Postsurgical follow-up of children with tympanostomy tubes: results of the American Academy of Otolaryngology-Head and Neck Surgery Pediatric Otolaryngology Committee National Survey. Otolaryngol Head Neck Surg 2000; 122:313.
  45. Sederberg-Olsen JF, Sederberg-Olsen AE, Jensen AM. Late sequelae related to treatment with ventilation tubes for secretory otitis media in ENT practice. In: Recent advances in otitis media, Mogi G, Honjo I, Tetsuo I, Takasaka T (Eds), Kugler Publications, Amsterdam 1994. p.843.
  46. Manning SC, Brown OE, Roland PS, Phillips DL. Incidence of sensorineural hearing loss in patients evaluated for tympanostomy tubes. Arch Otolaryngol Head Neck Surg 1994; 120:881.
  47. Emery M, Weber PC. Hearing loss due to myringotomy and tube placement and the role of preoperative audiograms. Arch Otolaryngol Head Neck Surg 1998; 124:421.
  48. Estrem SA, Batra PS. Conductive hearing loss associated with pressure equalization tubes. Otolaryngol Head Neck Surg 2000; 122:349.
  49. Valtonen HJ, Qvarnberg YH, Nuutinen J. Otological and audiological outcomes five years after tympanostomy in early childhood. Laryngoscope 2002; 112:669.
  50. Cheong KH, Hussain SS. Management of recurrent acute otitis media in children: systematic review of the effect of different interventions on otitis media recurrence, recurrence frequency and total recurrence time. J Laryngol Otol 2012; 126:874.
  51. Bluestone CD, Klein JO. Otitis media in infants and children, WB Saunders Co, Philadelphia 1988. p.89.
  52. Westine JG, Giannoni CM, Gajewski B, Antonelli PJ. Opening plugged tympanostomy tubes. Laryngoscope 2002; 112:1342.
  53. Spraggs PD, Robinson PJ, Ryan R, et al. A prospective randomised trial of the use of sodium bicarbonate and hydrogen peroxide ear drops to clear a blocked tympanostomy tube. Int J Pediatr Otorhinolaryngol 1995; 31:207.
  54. Mandel EM, Casselbrant ML, Kurs-Lasky M. Acute otorrhea: bacteriology of a common complication of tympanostomy tubes. Ann Otol Rhinol Laryngol 1994; 103:713.
  55. Ruohola A, Heikkinen T, Jero J, et al. Oral prednisolone is an effective adjuvant therapy for acute otitis media with discharge through tympanostomy tubes. J Pediatr 1999; 134:459.
  56. Schneider ML. Bacteriology of otorrhea from tympanostomy tubes. Arch Otolaryngol Head Neck Surg 1989; 115:1225.
  57. Sutton DV, Derkay CS, Darrow DH, Strasnick B. Resistant bacteria in middle ear fluid at the time of tympanotomy tube surgery. Ann Otol Rhinol Laryngol 2000; 109:24.
  58. Stol K, Diavatopoulos DA, Graamans K, et al. Inflammation in the middle ear of children with recurrent or chronic otitis media is associated with bacterial load. Pediatr Infect Dis J 2012; 31:1128.
  59. Azadarmaki R, Gaughan JP, Isaacson G. Failed tube extrusion is not a random event in children or their siblings. Laryngoscope 2008; 118:1248.
  60. Cunningham MJ, Eavey RD, Krouse JH, Kiskaddon RM. Tympanostomy tubes: experience with removal. Laryngoscope 1993; 103:659.
  61. Pribitkin EA, Handler SD, Tom LW, et al. Ventilation tube removal. Indications for paper patch myringoplasty. Arch Otolaryngol Head Neck Surg 1992; 118:495.
  62. Lentsch EJ, Goudy S, Ganzel TM, et al. Rate of persistent perforation after elective tympanostomy tube removal in pediatric patients. Int J Pediatr Otorhinolaryngol 2000; 54:143.
  63. Bluestone CD. Otologic surgical procedures. In: Atlas of pediatric otolaryngology, Bluestone CD, Stool SE (Eds), WB Saunders Co, Philadelphia 1995. p.38.
  64. Bluestone CD, Beery QC, Cantekin EI, Paradise JL. Eustachian tube ventilatory function in relation to cleft palate. Ann Otol Rhinol Laryngol 1975; 84:333.
  65. Smith TL, DiRuggiero DC, Jones KR. Recovery of eustachian tube function and hearing outcome in patients with cleft palate. Otolaryngol Head Neck Surg 1994; 111:423.
  66. Smith LK, Gubbels SP, MacArthur CJ, Milczuk HA. The effect of the palatoplasty method on the frequency of ear tube placement. Arch Otolaryngol Head Neck Surg 2008; 134:1085.
  67. Saito T, Iwaki E, Kohno Y, et al. Prevention of persistent ear drum perforation after long-term ventilation tube treatment for otitis media with effusion in children. Int J Pediatr Otorhinolaryngol 1996; 38:31.
  68. Courteney-Harris RG, Ford GR, Ganiwalla TM, Mangat KS. Closure of tympanic membrane perforation after the removal of Goode-type tympanostomy tubes: the use of silastic sheeting. J Laryngol Otol 1992; 106:960.
  69. Kay DJ, Nelson M, Rosenfeld RM. Meta-analysis of tympanostomy tube sequelae. Otolaryngol Head Neck Surg 2001; 124:374.
  70. DeRosa J, Grundfast KM. Surgical management of otitis media. Pediatr Ann 2002; 31:814.
  71. Stenstrom R, Pless IB, Bernard P. Hearing thresholds and tympanic membrane sequelae in children managed medically or surgically for otitis media with effusion. Arch Pediatr Adolesc Med 2005; 159:1151.
  72. Vaile L, Williamson T, Waddell A, Taylor G. Interventions for ear discharge associated with grommets (ventilation tubes). Cochrane Database Syst Rev 2006; :CD001933.
  73. Golz A, Netzer A, Joachims HZ, et al. Ventilation tubes and persisting tympanic membrane perforations. Otolaryngol Head Neck Surg 1999; 120:524.
  74. Nichols PT, Ramadan HH, Wax MK, Santrock RD. Relationship between tympanic membrane perforations and retained ventilation tubes. Arch Otolaryngol Head Neck Surg 1998; 124:417.
  75. Koch WM, Friedman EM, McGill TJ, Healy GB. Tympanoplasty in children. The Boston Children's Hospital experience. Arch Otolaryngol Head Neck Surg 1990; 116:35.
  76. Rollin M, Rogers P, Robinson P. Natural history of pediatric tympanic membrane perforation. Otol Neurotol 2011; 32:246.
  77. Saliba I, Abela A, Arcand P. Tympanic membrane perforation: size, site and hearing evaluation. Int J Pediatr Otorhinolaryngol 2011; 75:527.
  78. Gross CW, Bassila M, Lazar RH, et al. Adipose plug myringoplasty: an alternative to formal myringoplasty techniques in children. Otolaryngol Head Neck Surg 1989; 101:617.
  79. Deddens AE, Muntz HR, Lusk RP. Adipose myringoplasty in children. Laryngoscope 1993; 103:216.
  80. Bluestone CD, Cantekin EI, Douglas GS. Eustachian tube function related to the results of tympanoplasty in children. Laryngoscope 1979; 89:450.
  81. Manning SC, Cantekin EI, Kenna MA, Bluestone CD. Prognostic value of eustachian tube function in pediatric tympanoplasty. Laryngoscope 1987; 97:1012.
  82. Lin AC, Messner AH. Pediatric tympanoplasty: factors affecting success. Curr Opin Otolaryngol Head Neck Surg 2008; 16:64.
  83. Tos M, Stangerup SE. Hearing loss in tympanosclerosis caused by grommets. Arch Otolaryngol Head Neck Surg 1989; 115:931.
  84. Pichichero ME, Berghash LR, Hengerer AS. Anatomic and audiologic sequelae after tympanostomy tube insertion or prolonged antibiotic therapy for otitis media. Pediatr Infect Dis J 1989; 8:780.
  85. Koc A, Uneri C. Sex distribution in children with tympanosclerosis after insertion of a tympanostomy tube. Eur Arch Otorhinolaryngol 2001; 258:16.
  86. Friedman EM, Sprecher RC, Simon S, Dunn JK. Quantitation and prevalence of tympanosclerosis in a pediatric otolaryngology clinic. Int J Pediatr Otorhinolaryngol 2001; 60:205.
  87. Schuknecht HF. Pathology of the ear, Harvard University Press, Cambridge, MA 1974. p.256.
  88. Rakover Y, Keywan K, Rosen G. Comparison of the incidence of cholesteatoma surgery before and after using ventilation tubes for secretory otitis media. Int J Pediatr Otorhinolaryngol 2000; 56:41.
  89. Klingensmith MR, Strauss M, Conner GH. A comparison of retention and complication rates of large-bore (Paparella II) and small-bore middle ear ventilating tubes. Otolaryngol Head Neck Surg 1985; 93:322.
  90. Mawson SR, Fagan P. Tympanic effusions in children. Long-term results of treatment by myringotomy, aspiration and indwelling tubes (grommets). J Laryngol Otol 1972; 86:105.
  91. Pappas JJ. Middle ear ventilation tubes. Laryngoscope 1974; 84:1098.
  92. Tos M, Stangerup SE, Larsen P. Dynamics of eardrum changes following secretory otitis. A prospective study. Arch Otolaryngol Head Neck Surg 1987; 113:380.
  93. Spilsbury K, Miller I, Semmens JB, Lannigan FJ. Factors associated with developing cholesteatoma: a study of 45,980 children with middle ear disease. Laryngoscope 2010; 120:625.
  94. Grimes ER, Isaacson G. The mechanical reduction of early acquired cholesteatomas in children: indications and limitations. Ear Nose Throat J 2006; 85:252, 254, 256.