Contemporary Tympanostomy Tube Complications in Children: A Population-Based Longitudinal Study

Objective To describe the current tympanostomy tube insertion (TTI) complication rates occurring within 3 years of surgery in the post-intervention era. Current TTI complication rates in children are based on reports from a meta-analysis that was published in 2001, reporting on 16 to 26% otorrhea rates, cholesteatoma development of 0.7%, and tympanic membrane perforation (TMP) of 2.2 to 16%. Since then, interventions aimed at reducing pediatric otitis media burden have been largely implemented worldwide, and indications for TTI have been published. Study Design Population-based longitudinal study. Data were anonymously retrieved from a big stable healthcare database between 2005 and 2021. Setting Hospitals and ambulatory surgical centers, nationwide. Patients Children who underwent TTI and completed 3 postoperative follow-up years within the health insurance. We excluded children with previous otological surgery and congenital craniofacial anomalies. Children were categorized into the younger (0-<7 yr) and older (7-18 yr) age groups. Intervention TTI (therapeutic). Main Outcome Measures Number of TTI performed per 100,000 children per study year, and cumulative incidence of these postoperative complications: TT removal, otorrhea, TMP, cholesteatoma development, and need for mastoidectomy. Results Of the 19,920 unique children identified, 86.6% were in the younger age group with a mean age of 3.57 ± 1.59 years, and 61% were boys. At the end of follow-up, older children had statistically significantly higher TMP (6.9% versus 3.3%, p < 0.001), TT removal (5.1% versus 3.8%, p < 0.001), cholesteatoma (2.2% versus 0.8%, p < 0.001), and mastoidectomy (0.8% versus 0.3%, p < 0.001) rates when compared with younger children, respectively. Younger children experienced higher otorrhea rates when compared with older children (11% versus 6.4%, p < 0.001) but for a shorter period (324 ± 290 versus 404 ± 303 days, p < 0.001). Conclusions Post-TTI complication rates are lower in the post-intervention era, except for cholesteatoma. This current quantitative appreciation of TTI complications can help both patients and caregivers define realistic postoperative expectations.