Interventions for the prevention of postoperative ear discharge after insertion of ventilation tubes (grommets) in children

Syed, Mohammed Iqbal; Suller, Sharon; Browning, George G.; Akeroyd, Michael A.

doi:10.1111/coa.12150

Cited by 5 publications

(4 citation statements)

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“…Management, therefore, focuses either on prevention at that early stage or treatment of episodes that occur at a later stage. Many perioperative interventions have been tested and have shown to be of some benefit in preventing early postoperative ear discharge: saline washout of the middle ear or application of antibiotics with or without corticosteroid ear drops during tube surgery and the use of topical or systemic antibiotics during the early postoperative period 191 . The largest effects of these interventions were found in studies in which the risk of children developing early postoperative ear discharge was high 191 .…”

Section: Ventilation Tube-associated Ear Dischargementioning

confidence: 99%

Otitis media

Schilder

Chonmaitree

Cripps

et al. 2016

Nat Rev Dis Primers

419

361

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Otitis media (OM) or middle ear inflammation is a spectrum of diseases, including acute otitis media (AOM), otitis media with effusion (OME; 'glue ear') and chronic suppurative otitis media (CSOM). OM is among the most common diseases in young children worldwide. Although OM may resolve spontaneously without complications, it can be associated with hearing loss and life-long sequelae. In developing countries, CSOM is a leading cause of hearing loss. OM can be of bacterial or viral origin; during 'colds', viruses can ascend through the Eustachian tube to the middle ear and pave the way for bacterial otopathogens that reside in the nasopharynx. Diagnosis depends on typical signs and symptoms, such as acute ear pain and bulging of the tympanic membrane (eardrum) for AOM and hearing loss for OME; diagnostic modalities include (pneumatic) otoscopy, tympanometry and audiometry. Symptomatic management of ear pain and fever is the mainstay of AOM treatment, reserving antibiotics for children with severe, persistent or recurrent infections. Management of OME largely consists of watchful waiting, with ventilation (tympanostomy) tubes primarily for children with chronic effusions and hearing loss, developmental delays or learning difficulties. The role of hearing aids to alleviate symptoms of hearing loss in the management of OME needs further study. Insertion of ventilation tubes and adenoidectomy are common operations for recurrent AOM to prevent recurrences, but their effectiveness is still debated. Despite reports of a decline in the incidence of OM over the past decade, attributed to the implementation of clinical guidelines that promote accurate diagnosis and judicious use of antibiotics and to pneumococcal conjugate vaccination, OM continues to be a leading cause for medical consultation, antibiotic prescription and surgery in high-income countries.

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Section: Ventilation Tube-associated Ear Dischargementioning

confidence: 99%

Otitis media

Schilder

Chonmaitree

Cripps

et al. 2016

Nat Rev Dis Primers

419

361

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“…In 54% of patients, TTO resolved only after TT extrusion and/or removal, with or without TT replacement. 52 of prevention of postoperative TTO found 15 eligible RCTs, of which 7 were considered at low risk of bias. Four treatments were found to reduce the rate of otorrhea up to 2 weeks after surgery: multiple saline washouts during surgery, single application of topical antibiotic/steroid drops during surgery, prolonged application of topical antibiotic/steroid drops, and prolonged application of oral antibacterial agents/steroids.…”

Section: Treatment Of Tto In An Rct Van Dongen Et Al 49 Compared 3 mentioning

confidence: 99%

Panel 7: Otitis Media: Treatment and Complications

Schilder

Marom²,

Bhutta

et al. 2017

Otolaryngol.--head neck surg.

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Objective We aimed to summarize key articles published between 2011 and 2015 on the treatment of (recurrent) acute otitis media, otitis media with effusion, tympanostomy tube otorrhea, chronic suppurative otitis media and complications of otitis media, and their implications for clinical practice. Data Sources PubMed, Ovid Medline, the Cochrane Library, and Clinical Evidence (BMJ Publishing). Review Methods All types of articles related to otitis media treatment and complications between June 2011 and March 2015 were identified. A total of 1122 potential related articles were reviewed by the panel members; 118 relevant articles were ultimately included in this summary. Conclusions Recent literature and guidelines emphasize accurate diagnosis of acute otitis media and optimal management of ear pain. Watchful waiting is optional in mild to moderate acute otitis media; antibiotics do shorten symptoms and duration of middle ear effusion. The additive benefit of adenoidectomy to tympanostomy tubes in recurrent acute otitis media and otitis media with effusion is controversial and age dependent. Topical antibiotic is the treatment of choice in acute tube otorrhea. Symptomatic hearing loss due to persistent otitis media with effusion is best treated with tympanostomy tubes. Novel molecular and biomaterial treatments as adjuvants to surgical closure of eardrum perforations seem promising. There is insufficient evidence to support the use of complementary and alternative treatments. Implications for Practice Emphasis on accurate diagnosis of otitis media, in its various forms, is important to reduce overdiagnosis, overtreatment, and antibiotic resistance. Children at risk for otitis media and its complications deserve special attention.

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“…Standard intraoperative protocols for otorrhea prophylaxis involve the use of topical ofloxacin drops or topical ciprofloxacin-dexamethasone drops (5,8,9). These protocols only apply to ears that are dry at the time of tympanostomy with no active infection.…”

mentioning

confidence: 99%

“…These protocols only apply to ears that are dry at the time of tympanostomy with no active infection. At the same time, the superiority of any single prophylaxis for ears that do not demonstrate infection intraoperatively is still debated (5,9).…”

mentioning

confidence: 99%

Cost-effectiveness of Inpatient Tympanostomy Prophylaxis

Yeakel

Pasick

Kirchner

et al. 2021

Otology &Amp; Neurotology

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Objective: Tympanostomy is the most common pediatric ambulatory surgery. Post-tympanostomy otorrhea is a prevalent complication leading to high costs to patients for treatment. The cost-effectiveness of intraoperative prophylaxis for both patient and institution has not been examined. Study Design: An analytical observational study of data collected from the literature and purchasing records. Methods: A break-even analysis was performed to determine the required absolute risk reduction (ARR) and final infection rate in post-tympanostomy otorrhea to make intraoperative prophylaxis using ofloxacin and ciprofloxacin dexamethasone otic version cost effective with the following outpatient treatments: ofloxacin, ciprofloxacin-dexamethasone ophthalmic version, and ciprofloxacin-dexamethasone otic version. Absolute risk reduction is a statistic used to express the difference in risk between a treatment and control. The conservative initial infection rate used was 10%.Results: Ofloxacin intraoperative prophylaxis was not cost effective when prescribing ofloxacin outpatient treatment with an ARR of 0.20. Ofloxacin intraoperative prophylaxis was cost-effective with an ARR of 0.08 for ciprofloxacindexamethasone ophthalmic version outpatient treatment. Ofloxacin intraoperative prophylaxis was cost-effective for ciprofloxacin-dexamethasone otic version outpatient treatment with an ARR of 0.01. Ciprofloxacin-dexamethasone intraoperative prophylaxis was not cost-effective when prescribing ofloxacin outpatient treatment with an ARR of 1.52. Ciprofloxacin-dexamethasone intraoperative prophylaxis was not cost-effective when prescribing ciprofloxacin-dexamethasone ophthalmic version outpatient treatment with an ARR of 0.60. Ciprofloxacindexamethasone intraoperative prophylaxis was cost effective when prescribing ciprofloxacin-dexamethasone otic version outpatient treatment with an ARR of 0.09. Conclusion: Intraoperative prophylaxis can be cost effective for preventing post-tympanostomy otorrhea. Physicians can use this economic model to determine the cost-effectiveness of these interventions for their patients and institutions.

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Interventions for the prevention of postoperative ear discharge after insertion of ventilation tubes (grommets) in children

Cited by 5 publications

References 0 publications

Otitis media

Otitis media

Panel 7: Otitis Media: Treatment and Complications

Cost-effectiveness of Inpatient Tympanostomy Prophylaxis

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