Role of Biofilms in Post-Tympanostomy Tube Otorrhea

Marom, Tal; Habashi, Nadeem; Cohen, Robert; Tamir, Sharon

doi:10.1177/0145561320914437

Cited by 10 publications

(9 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Current understanding in the pathophysiology of acute recurrent and chronic otorrhea has now focused on the role of bacterial biofilm development in both the middle ear and on tympanostomy tubes. [10][11][12] It is thought that the presence of biofilms allows microorganisms to survive at a low metabolic rate, at times avoiding detection, and still contributing to pathologic responses from the middle ear. 13,14 Although this study did not perform a biofilm analysis, 40% of the intraoperative culture results showed no growth and a third were positive for MRSA; findings that appear to be in concordance with the literature for refractory otorrhea and chronic otitis media with effusion.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Mastoidectomy With Antibiotic Catheter Irrigation for Patients With Draining Ventilation Tubes

et al. 2021

View full text Add to dashboard Cite

Objectives: To evaluate the effectiveness of mastoidectomy with antibiotic catheter irrigation in patients with chronic tympanostomy tube otorrhea. Methods: A chart review of adult and pediatric patients with persistent tympanostomy tube otorrhea who had failed outpatient medical management and underwent mastoidectomy with placement of a temporary indwelling catheter for antibiotic instillation was performed. Patients were retrospectively followed for recurrent drainage after 2 months and outcomes were categorized as resolution (0-1 episodes of otorrhea or otitis media with effusion during follow-up), improvement (2-3 episodes), or continued episodic (>3 episodes). Results: There were 22 patients and 23 operated ears. Median age was 46 years (interquartile range, IQR = 29-65). The median duration of otorrhea from referral was 5.5 months (IQR = 2.8-12). Following surgery, 14 ears had resolution of drainage, 6 had improvement, and 3 had episodic. The observed percentage of resolved/improved ears (87%) was significant ( P = .0005, 95% CI = 67.9%-95.5%). Median follow-up time was 25 months (IQR = 12-59). Pre and postoperative pure tone averages improved (difference of medians = −3.3 dB, P = .02) with no significant difference in word recognition scores ( P = .68). Methicillin-resistant Staphylococcus aureus was the most common isolated microbe while no growth was most frequently noted on intraoperative cultures. Conclusions: Mastoidectomy with antibiotic catheter irrigation may be an effective surgical strategy, and single stage alternative to intravenous antibiotics, for select patients with persistent tube otorrhea who have failed topical and oral antibiotics.

show abstract

Section: Discussionmentioning

confidence: 99%

Outcomes of Mastoidectomy With Antibiotic Catheter Irrigation for Patients With Draining Ventilation Tubes

et al. 2021

View full text Add to dashboard Cite

show abstract

“…It has been shown that the dynamic liquid interface present on the liquid-infused materials not only improves transport properties but also resists nearly all biological attachment and colonization mechanisms (37)(38)(39)(40)(41). Here, we tested the ability of the medical-grade silicone oil-infused silicone elastomer to repel bacteria and blood, particularly the pathogenic biofilms that underlie the widespread problem of device-associated infections (42), and to prevent attachment and ingrowth of human tissue on or in the tube, potentially avoiding the device rejection that now leads to repeated surgeries.…”

Section: Biological Adhesion and Growthmentioning

confidence: 99%

Design of medical tympanostomy conduits with selective fluid transport properties

et al. 2023

View full text Add to dashboard Cite

Implantable tubes, shunts, and other medical conduits are crucial for treating a wide range of conditions from ears and eyes to brain and liver but often impose serious risks of device infection, obstruction, migration, unreliable function, and tissue damage. Efforts to alleviate these complications remain at an impasse because of fundamentally conflicting design requirements: Millimeter-scale size is required to minimize invasiveness but exacerbates occlusion and malfunction. Here, we present a rational design strategy that reconciles these trade-offs in an implantable tube that is even smaller than the current standard of care. Using tympanostomy tubes (ear tubes) as an exemplary case, we developed an iterative screening algorithm and show how unique curved lumen geometries of the liquid-infused conduit can be designed to co-optimize drug delivery, effusion drainage, water resistance, and biocontamination/ingrowth prevention in a single subcapillary–length-scale device. Through extensive in vitro studies, we demonstrate that the engineered tubes enabled selective uni- and bidirectional fluid transport; nearly eliminated adhesion and growth of common pathogenic bacteria, blood, and cells; and prevented tissue ingrowth. The engineered tubes also enabled complete eardrum healing and hearing preservation and exhibited more efficient and rapid antibiotic delivery to the middle ear in healthy chinchillas compared with current tympanostomy tubes, without resulting in ototoxicity at up to 24 weeks. The design principle and optimization algorithm presented here may enable tubes to be customized for a wide range of patient needs.

show abstract

“…Biofilms are known to form on TTs, helping protect bacteria from both antimicrobial treatments and the host immune system, in turn contributing to TTO ( 21 ). In addition to TT design modifications to prevent biofilm formation, targeted treatments to degrade biofilms are under development.…”

Section: Novel Agents For Ttomentioning

confidence: 99%