Management of refractory tympanostomy tube otorrhea with ear wicks.

INTRODUCTION Tympanostomy tube placement is one of the most common surgical procedures performed in children. Approximately 1 million tympanostomy tube placement procedures are performed on a yearly basis in the United States. The literature reports varying rates of postoperative tympanostomy tube otorrhea, ranging from 1.7% to 83%. Reported rates of recurrent postoperative tube otorrhea are 7.4% and chronic otorrhea 3.8%. Risk factors for post-tympanostomy tube otorrhea may include age, type of effusion, bacteriology, eustachian tube status, water exposure in some individuals, and viral infections. This complication negatively impacts patients’ hearing and contributes to increased healthcare cost. Although the use of ototopical medications usually resolves otorrhea, a subset of patients do not respond. Traditionally, the management of patients with otorrhea refractory to oral and topical antibiotics, and office debridement, is admission for intravenous antibiotics. These patients may require further surgical management with either tube removal and replacement or mastoidectomy. There is little discussion in the literature regarding effective management of otorrhea with wick placement prior to delivery of ototopical medication. We report our experience and technique for management of refractory tympanostomy tube otorrhea with ear wick placement. MATERIALS AND METHODS This was a retrospective medical record review from 2011 to 2012 at the Children’s Hospital of Pittsburgh of the University of Pittsburgh Medial Center (UPMC). Approval of the institutional review board at UPMC was obtained prior to the study onset. We had the following inclusion criteria: patients <18 years old, history of tympanostomy tube placement, otorrhea while tubes in place, otorrhea refractory to topical drops, oral antibiotics, office debridement and good aural toilet, and ear wick placement for otorrhea management. There were seven patients who met the criteria from 2011 to 2012. We describe the outcomes of patients after wick placement and ciprofloxacin/dexamethasone otic drops. For all eligible patients, the medical records were reviewed and a database was established recording the following variables for all patients: 1) demographics: age of tube placement, gender, and laterality; 2) location of placement of tympanostomy tube; 3) operative findings of effusion, type of tympanostomy tube, and number of tube placements; 4) past and family medical history; 5) social history: daycare, siblings, pets, smoke exposure; 6) onset and length of otorrhea; and 7) ear culture results. At the clinic visit following failure of topical and oral antibiotics, the ear was thoroughly debrided, Merocel R (Medtronic, Inc., Fl., USA) ear wicks were placed in the draining ear, and patients were immediately started on ciprofloxacin/dexamethasone otic drops. Cultures were also obtained at this time. The parents were counseled on proper instillation of ear drops. We recommended that they keep the child’s affected ear parallel to the ceiling for at least 10 seconds, and to gently press on the tragus several times. Patients had scheduled follow-up visits in 1 week to remove the wick and reexamine the ear; and further follow-up was set at 1 to 3 months.