Clin Exp Otorhinolaryngol.  2022 Nov;15(4):326-334. 10.21053/ceo.2022.00934.

Factors Affecting the Extrusion Rate and Complications After Ventilation Tube Insertion: A Multicenter Registry Study on the Effectiveness of Ventilation Tube Insertion in Pediatric Patients With Chronic Otitis Media With Effusion—Part II

• Yoo MH
• Cho YS
• Choi J
• Choung YH
• Chung JH
• Chung JW
• Han GC
• Jun BC
• Kim DK
• Kim KS
• Lee JH
• Lee KY
• Lee SH
• Moon IS
• Park HJ
• Park SN
• Rhee J
• Seo JH
• Yeo SG

• KMID: 2536531
• DOI: http://doi.org/10.21053/ceo.2022.00934

Abstract

Objectives
. The impacts of ventilation tube (VT) type and effusion composition on the VT extrusion rate and complications in children with otitis media remain unclear. This part II study evaluated the factors affecting the extrusion rate, recurrence rate, and complications of VT insertion.
Methods
. A prospective study was conducted between June 2014 and December 2016 (the EVENT study [analysis of the effectiveness of ventilation tube insertion in pediatric patients with chronic otitis media]), with follow-up data collected until the end of 2017. Patients aged <15 years diagnosed with otitis media with effusion who received VT insertion were recruited at 15 tertiary hospitals. The primary outcomes were time to extrusion of VT, time to effusion recurrence, and complications.
Results
. Data from 401 patients were analyzed. After excluding the results of long-lasting tubes (Paparella type II and T-tubes), silicone tubes (Paparella type I) exhibited a significantly longer extended time to extrusion (mean, 400 days) than titanium tubes (collar-button-type 1.0 mm: mean, 312 days; P<0.001). VT material (hazard ratio [HR], 2.117, 95% confidence interval [CI], 1.254–3.572; P=0.005), age (HR, 3.949; 95% CI, 1.239–12.590; P=0.02), and effusion composition (P=0.005) were significantly associated with the time to recurrence of middle ear effusion. Ears with purulent (mean, 567 days) and glue-like (mean, 588 days) effusions exhibited a shorter time to recurrence than ears with serous (mean, 846 days) or mucoid (mean, 925 days) effusions. The revision VT rates during follow-up were 3.5%, 15.5%, 10.4%, and 38.9% in ears with serous, mucoid, glue-like, and purulent effusions, respectively (P<0.001). The revision surgery rates were higher among patients aged <7 years than among those aged ≥7 years.
Conclusion
. Silicone tubes (Paparella type I) were less prone to early extrusion than titanium 1.0 mm tubes. VT type, patient age, and effusion composition affected the time to recurrence of effusion.

Keyword

Otitis Media; Tympanostomy Tube; Recurrence; Titanium; Silicone; Complication

Figure

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  Fig. 1. Cox hazard ratio model. (A) Time to tube extrusion according to the type of material (in short-lasting tubes). Silicone (Paparella type I) tubes exhibited a significantly longer time to extrusion than titanium tubes (1.0 mm collar-button-type). (B) Time to effusion recurrence according to age. The time to effusion recurrence was significantly different between patients aged <7 years and those aged ≥7 years. (C) Time to effusion recurrence according to the type of material. Silicone tubes exhibited a significantly longer time than titanium tubes. (D) Time to effusion recurrence according to middle ear effusion composition. Ears with serous (846 days) and mucoid (925 days) effusions exhibited significantly delayed recurrence compared to those with glue-like (588 days) or purulent (567 days) effusions.

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