Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Otolaryngology-Head and Neck Surgery, Monash Health, Melbourne, Australia.
Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Otolaryngology-Head and Neck Surgery, Monash Health, Melbourne, Australia.
Int J Pediatr Otorhinolaryngol. 2021 Mar;142:110601. doi: 10.1016/j.ijporl.2020.110601. Epub 2020 Dec 30.
Insertion of middle ear ventilation tubes (MEVT), tympanostomy tubes or grommets is one of the most common paediatric surgical procedures performed by ENT surgeons worldwide. Outcomes may be complicated by postoperative otorrhoea and ventilation tube blockage.
To identify risk factors associated with early postoperative complications of MEVT insertion.
In a case-control study, set in a tertiary hospital in Melbourne, Australia, 590 paediatric patients undergoing grommet insertion between February 2017 and February 2018, 311 patients (205 males & 106 females; median age of 3.86 years) met the inclusion criteria and had identical middle ear status bilaterally.
Tympanostomy tube insertion and postoperative topical otic antibiotic drops.
Patient age, gender, weight/BMI percentile, intraoperative middle ear status, number of previous grommets, type of surgery, season of surgery, diagnosis and time to first medical review were examined. The duration of topical otic antibiotic drops used and tube patency and presence of otorrhoea at 6-week postoperative review were also recorded.
At the first medical review, 8.7% of patients (n = 27) developed otorrhoea from one or both ears, 6.4% of patients (n = 20) had an obstructed MEVT in one or both ears. Exposure to intraoperative [IO] and postoperative [PO] antibiotic drops were significantly less associated with developing postoperative otorrhoea compared to non-exposure (IO: Odds Ratio [OR] = 0.15, 95%CI 0.04 to 0.57, p = 0.005; PO: OR = 0.21, 95%CI 0.58 to 0.76, p = 0.017). There were no statistically significant associations between antibiotic drop exposure and grommet blockage (p > 0.05). There was a significant association between developing postoperative otorrhoea and patients receiving surgery during the colder months of Winter/Autumn (OR = 3.17, 95%CI 1.14 to 8.84, p = 0.028), as well as patients aged less than 3 years (OR = 2.66, 95%CI 1.01 to 7.03, p = 0.049). There was a statistically significant association between serous effusions and grommet blockage compared to no effusion (OR = 4.03, 95%CI 1.03 to 15.7, p = 0.045). There were no statistically significant associations identified between otorrhoea and gender, weight/BMI percentile, intraoperative middle ear status, number of previous grommets, type of surgery, diagnosis and time to first medical review. There were no statistically significant associations between grommet blockage and age, gender, indication for surgery, concurrent surgery, season or number of previous grommets.
8.7% of patients developed otorrhoea within 6 weeks post-operatively. Undergoing the procedure during winter/autumn, age <3 years were associated with developing otorrhoea. Topical antibiotic exposure was inversely associated with developing postoperative otorrhoea. 6.4% of patients had grommet blockage. Presence of serous middle ear effusion intraoperatively was a statistically significant indicator for developing grommet blockage.
中耳通气管（MEVT）、鼓膜切开术或鼓膜置管术是全球耳鼻喉科医生最常进行的小儿外科手术之一。术后可能会出现耳漏和通气管堵塞等并发症。
确定 MEVT 插入术后早期并发症的相关风险因素。
在澳大利亚墨尔本的一家三级医院进行的病例对照研究中，2017 年 2 月至 2018 年 2 月期间，590 名接受鼓膜置管术的儿科患者中，311 名患者（205 名男性和 106 名女性；中位年龄为 3.86 岁）符合纳入标准，且双侧中耳状态相同。
鼓膜切开术和术后局部滴耳抗生素。
检查患者年龄、性别、体重/体重指数百分位、术中中耳状况、既往鼓膜置管数量、手术类型、手术季节、诊断以及首次医疗随访时间。还记录了局部滴耳抗生素的使用时间、通气管通畅性以及 6 周术后随访时的耳漏情况。
在首次医疗随访时，8.7%（n=27）的患者出现单侧或双侧耳漏，6.4%（n=20）的患者单侧或双侧 MEVT 堵塞。与未暴露相比，术中[IO]和术后[PO]使用抗生素滴耳液与发生术后耳漏的相关性显著降低（IO：优势比[OR]0.15，95%CI 0.04 至 0.57，p=0.005；PO：OR 0.21，95%CI 0.58 至 0.76，p=0.017）。抗生素滴耳液暴露与鼓膜堵塞之间无统计学显著相关性（p>0.05）。术后耳漏与患者在冬季/秋季接受手术（OR 3.17，95%CI 1.14 至 8.84，p=0.028）以及年龄小于 3 岁（OR 2.66，95%CI 1.01 至 7.03，p=0.049）显著相关。与无积液相比，浆液性中耳积液与鼓膜堵塞之间存在统计学显著相关性（OR 4.03，95%CI 1.03 至 15.7，p=0.045）。性别、体重/体重指数百分位、术中中耳状况、既往鼓膜置管数量、手术类型、诊断和首次医疗随访时间与耳漏之间无统计学显著相关性。年龄、性别、手术指征、同期手术、季节和既往鼓膜置管数量与鼓膜堵塞之间无统计学显著相关性。
8.7%的患者在术后 6 周内出现耳漏。在冬季/秋季进行手术、年龄小于 3 岁与耳漏发生相关。局部使用抗生素与发生术后耳漏呈负相关。6.4%的患者出现鼓膜堵塞。术中存在浆液性中耳积液是发生鼓膜堵塞的统计学显著指标。
