What are the rate and predictors of electing for a second bilateral myringotomy and tympanostomy tube placement (BMT) in children with recurrent acute otitis media (RAOM)?
Children who underwent BMT for RAOM were more likely to undergo second BMT if they were of younger age, had a family history of RAOM/BMT, or were found to have middle ear fluid intraoperatively. The overall second BMT rate for children with RAOM is lower than in studies examining all BMT indications.
Explore this issue:June 2018
Background: BMT represents the most commonly performed procedure requiring general anesthesia in the United States. A multitude of studies have demonstrated the efficacy and safety of BMT in children with RAOM. The need for further surgery should be discussed as a component of the informed consent process. Further surgery most often consists of repeat BMT.
Study design: Retrospective chart review.
Setting: Department of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Penn.
Synopsis: The study population was limited to children undergoing their first BMT and for the indication of RAOM only, which to our knowledge has never been reported on. Furthermore, the institution studied utilizes the same tympanostomy tube type—the modified Armstrong grommet tube. In this way, this study examines the largest subgroup of children undergoing BMT (RAOM) and with a consistent intervention.
Charts of 600 children who underwent BMT for RAOM between 2012 and 2014 were reviewed. The overall rate of a second BMT was 15.2% (91/600) and occurred a median of 1.58 years after the initial BMT. The most common indication was continued RAOM with extruded tubes. There was a higher rate of second BMT in patients of younger age (1.06 vs. 1.32 years old) and those with a positive family history of RAOM/BMT in a first-degree relative.
Identification of middle ear fluid intraoperatively but not preoperatively was associated with higher rates of second BMT. Children with bilateral intraoperative fluid or fluid both preoperatively and intraoperatively had greater higher risk of requiring second BMT. In this series, the finding of blocked tubes or tube otorrhea at the first postoperative visit were not predictive of an increased risk of second BMT.
Citation: Huyett P, Sturm JJ, Shaffer AD, Kitsko DJ, Chi DH. Second tympanostomy tube placement in children with recurrent acute otitis media. Laryngoscope. 2018;128:1476–1479.