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Prevention and management of tympanostomy tube otorrhea in children

INTRODUCTION

Tympanostomy tube otorrhea may occur immediately after tube insertion from an existing infection in the middle ear (acute otitis media, AOM), or later, with subsequent middle ear infections or infectious processes in the ear canal.

The prevention and management of tympanostomy tube otorrhea in children will be discussed here. An overview of tympanostomy tube placement and medical care of children with tympanostomy tubes, otitis media with effusion, and treatment and prevention of acute otitis media are presented separately. (See "Overview of tympanostomy tube placement and medical care of children with tympanostomy tubes" and "Otitis media with effusion (serous otitis media) in children" and "Acute otitis media in children: Treatment" and "Acute otitis media in children: Prevention of recurrence".)

TERMINOLOGY

Tympanostomy tube otorrhea — Tympanostomy tube otorrhea (TTO, also called post-tympanostomy tube otorrhea, PTTO), is defined as active drainage through an existing tympanostomy tube [1]. Early-onset TTO occurs within two weeks of tube placement, while late-onset TTO occurs more than two weeks after tube placement [2,3]. Chronic or persistent TTO usually refers to otorrhea of ≥6 to 8 weeks' duration [2,3]. Recurrent TTO refers to distinct episodes of TTO between which the otorrhea clears [2,3].

Chronic suppurative otitis media — Chronic suppurative otitis media (CSOM) is defined as purulent otorrhea that lasts for longer than six weeks despite treatment [1]. It may result from an unresolved or complicated AOM with perforation of the tympanic membrane or from a preexisting perforation that occurred spontaneously or after extrusion or removal of a tympanostomy tube. (See "Acute otitis media in children: Epidemiology, pathogenesis, clinical manifestations, and complications".)

PREVENTION OF TYMPANOSTOMY TUBE OTORRHEA

Early-onset — Approximately 10 to 20 percent of children who undergo placement of tympanostomy tubes develop otorrhea during the early post-operative period [2]. The rate of early post-operative otorrhea is not affected by surgical technique or preparation of the ear canal [4,5].
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