PEDIATRICS Vol. 107 No. 6 June 2001, pp. 1251-1258
Otorrhea in Young Children After Tympanostomy-Tube Placement for Persistent Middle-Ear Effusion: Prevalence, Incidence, and Duration
Received Jun 19, 2000; accepted Oct 2, 2000.
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From the Department of Pediatrics, * University of Pittsburgh
School of Medicine and Objective. To characterize the
occurrence of tube otorrhea after tympanostomy-tube placement (TTP) for
persistent middle-ear effusion (MEE) in a group of otherwise healthy
infants and young children.
Methods. In a long-term, prospective study of child
development in relation to early-life otitis media, we enrolled by 2 months of age healthy infants who presented for primary care at 1 of 2 urban hospitals or 1 of 2 small-town/rural and 4 suburban private
pediatric group practices. We monitored their middle-ear status
closely. Children who developed persistent MEE of specified durations
within the first 3 years of life became eligible for random assignment to undergo TTP either promptly or after an extended period if MEE
persisted. The present report concerns 173 randomly assigned children
who underwent bilateral TTP between ages 6 and 36 months and were
followed for at least 6 months thereafter. Episodes of tube otorrhea
were treated with oral antimicrobial drugs and, if persistent, with
ototopical medication.
Results. Socioeconomic status, as estimated from maternal
education and type of health insurance, was lowest at the urban sites
and highest at the suburban sites. The tenure of the 230 tubes that were extruded during the observation period ranged from 19 days to 38.5 months (mean = 13.8 months; median = 13.5 months). During the
first 18 months after TTP, the proportion of children who had tubes in
place and who developed 1 or more episodes of otorrhea increased
progressively, reaching 74.8% after 12 months and 83.0% after 18 months. The mean number of episodes per child was 0.79 in the first 6 months, 1.50 in the first 12 months, 2.17 in the first 18 months, and
2.82 in the first 24 months. Overall, otorrhea occurred earliest and
was most prevalent among urban children and occurred latest and was
least prevalent among suburban children. The mean estimated duration of
episodes of tube otorrhea was 16.0 days (standard deviation = 16.9 days), the median was 10 days, and the range was 3 to 131 days. The
duration was >30 days in 13.2% of the episodes. Six of the 173 children (3.5%) developed on 1 or more occasions tube otorrhea that
failed to improve satisfactorily with conventional outpatient
management. Five of these children were hospitalized to receive
parenteral antibiotic treatment, 1 child twice and 1 three times, and 1 also underwent tube removal. The sixth child underwent tube removal as
an outpatient.
Conclusions. Tube otorrhea is a common and often recurrent
and/or stubborn problem in young children who have undergone tube
placement for persistent MEE. The extent of the problem seems to be
related inversely to socioeconomic status. Tube otorrhea does not
always respond satisfactorily to outpatient management and for
resolution may require parenteral antimicrobial treatment and/or tube
removal.
Children's Hospital of Pittsburgh,
Pittsburgh, Pennsylvania.
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