Treatment of acute otorrhea in children with tympanostomy tubes

Abstract

Tympanostomy tube placement is one of the most common surgical procedures performed in children worldwide. Otorrhea, or ear discharge, is a frequent sequela in children with tubes; it is usually a symptom of a middle ear infection whereby fluid that has built up in the middle ear drains through the tube into the child’s ear canal. Acute tympanostomy tube otorrhea (ATTO) is mostly unpleasant and can smell bad; the underlying middle ear infection can cause general illness, pain and fever. Most episodes of tympanostomy tube otorrhea (TTO) last days to weeks; some children develop chronic otorrhea, which may cause considerable morbidity and hearing loss. Therefore, it is important that children with ATTO receive the best treatment. We performed an open-label, pragmatic trial in which we randomly assigned 230 children, 1 to 10 years of age, who had acute tympanostomy-tube otorrhea to receive antibiotic-glucocorticoid eardrops or oral antibiotics or to undergo initial observation. We found that antibiotic-glucocorticoid eardrops are more effective than oral antibiotics and initial observation in children with tympanostomy tubes suffering from uncomplicated acute otorrhea. In addition, in this thesis we report on the cost-effectiveness of these treatment strategies, on the results of our cohort study on the current incidence of TTO and its predictors, on the interobserver agreement between parents and physicians in the assessment of otorrhea in children after treatment, on the prevalences of bacteria and viruses found in otorrhea and nasopharyngeal samples of the children with ATTO who participated in our trial, and on our systematic review of studies reporting on the concordance between test results of nasopharyngeal and middle ear fluid samples in children with otitis media.