Pittsburgh Ear Associates, Allegheny General Hospital, Pittsburgh, PA, USA.
Department of Otolaryngology-Head & Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Ear Nose Throat J. 2023 Oct;102(10):673-679. doi: 10.1177/01455613211025742. Epub 2021 Jun 15.
To evaluate the effectiveness of mastoidectomy with antibiotic catheter irrigation in patients with chronic tympanostomy tube otorrhea.
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).
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 ( = .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, = .02) with no significant difference in word recognition scores ( = .68). Methicillin-resistant was the most common isolated microbe while no growth was most frequently noted on intraoperative cultures.
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.
评估乳突切除术联合抗生素导管灌洗治疗慢性鼓膜置管后耳漏的疗效。
对接受乳突切除术联合临时留置导管抗生素灌洗，且经门诊药物治疗失败、持续性鼓膜置管后耳漏的成人和儿科患者进行病历回顾。对术后 2 个月内复发引流的患者进行回顾性随访，并根据结果分为缓解（随访期间发生 0-1 次耳漏或中耳炎伴积液）、改善（2-3 次）或持续间歇性（>3 次）。
共纳入 22 例患者和 23 侧手术耳。中位年龄为 46 岁（四分位距 IQR = 29-65）。从转诊到耳漏的中位时间为 5.5 个月（IQR = 2.8-12）。术后 14 侧耳引流缓解，6 侧耳改善，3 侧耳间歇性发生。观察到的缓解/改善耳比例（87%）显著（ =.0005，95%CI = 67.9%-95.5%）。中位随访时间为 25 个月（IQR = 12-59）。纯音听阈平均值在术前和术后均改善（中位数差值=-3.3dB， =.02），但言语识别率无显著差异（ =.68）。耐甲氧西林 是最常见的分离微生物，而术中培养最常未发现生长。
对于经局部和口服抗生素治疗失败、持续性鼓膜置管后耳漏的选择患者，乳突切除术联合抗生素导管灌洗可能是一种有效的手术策略，可替代静脉使用抗生素的单阶段治疗。
