Otitis media with effusion: Recurrence after tympanostomy tube extrusion § Huseyin Yaman *, Suleyman Yilmaz, Ender Guclu, Bugra Subasi, Nihal Alkan, Ozcan Ozturk Duzce University Duzce Medical Faculty, Department of Otorhinolaryngology, Duzce, Turkey 1. Introduction Otitis media with effusion (OME) is the most common disease in children [1,2]. It is characterized by persistent mucoid or serous middle ear effusion, in the absence of acute inflammation [1,2]. Although microbial infections and Eustachian tube dysfunction are well known to be related in the pathogenesis of OME, the mechanism of OME is not yet fully established. This disease is associated with delayed speech development, learning problems, and temporary or permanent acquired hearing loss in children [1,2]. It often resolves spontaneously by 3 months. Conventional medical therapy for OME is necessary in the presence of a persistent effusion, antibiotics, decongestants, antihistamines and combinations of these agents are used. Many trials showed no significant benefits for antihistamines or decongestants compared with placebo [2]. OME is common between the ages of 6 months and 4 years [2,3]. OME is observed in more than 50% of children in the first year of life [2,3]. Many episodes resolve spontaneously within 3 months, but in about 30% to 40% of children OME recurs and 5% to 10% of episodes last 1 year or longer [2,3]. The treatments of OME include close follow-up only, medical treatment and surgery [2,4]. Failure of medical treatment of middle ear effusion frequently ends up with tympanostomy tube insertion. This operation is one of the most common surgical procedures performed in children for which general anesthesia is required. Otorrhea, granulation tissue, perforation, sclerotic changes in the tympanic membrane and cholesteatoma are the main complications of tympanostomy tube International Journal of Pediatric Otorhinolaryngology 74 (2010) 271–274 ARTICLE INFO Article history: Received 17 September 2009 Received in revised form 25 November 2009 Accepted 29 November 2009 Available online 30 December 2009 Keywords: Recurrence Tympanostomy tube Extrusion time Effusion ABSTRACT Objective: The incidence rate of recurrence of otitis media with effusion (OME) in children after tympanostomy tube extrusion and the relationship between recurrence and tube retention time was investigated. Also relationship between recurrence rate and initial age of tube insertion was analysed. Study Design: A retrospective case series of patients who had tympanostomy tube insertion. Methods: A total of 91 children (169 ears) were reviewed. Ears of children divided into three groups according to retention time of tympanostomy tubes. Group I: tympanostomy tube retention time less than 6 months. Group II: tympanostomy tube retention time 6 months to 12 months. Group III: tympanostomy tube retention time 12 months or more. Results: OME recurrence rate after tube extrusion was 20.7% in the study. The longer the tympanostomy tube retention time was the lower was the recurrence rate of OME. The comparison of the three groups indicated that recurrence rates were higher in group I (36.54%), than in group II (17.74%) and in group III (9.1%). There were statistically significant differences in recurrence rates between group I and group III, and between group I and II (p < 0.05, p < 0.05). However, the difference in recurrence rates between group II and group III was statistically not significant (p > 0.05). In the preschool age group and school age group, the recurrence rates were 5.5% and 15.4%, respectively. There was no significant difference between these two groups (p > 0.05). OME recurrence was observed in 9.9% of males and in 11% of females. There was no significant difference in recurrence rates between males and females (p > 0.05). Conclusion: After extrusion of tympanostomy tube, children should be followed-up regularly for recurrence of OME. The shorter the retention time of tympanostomy tubes was the higher was the recurrence rate. For the treatment of OME the ideal type of tubes should have the lowest complication and recurrence rates. Further studies are needed to ascertain the relationship between the incidence of OME and optimal tympanostomy tubes duration of tube stay in tympanic membrane. Therefore, new studies with larger series are necessary to investigate the correlation between the recurrence rates and different tympanostomy tubes after extrusion of tubes. ß 2009 Elsevier Ireland Ltd. All rights reserved. § Presented at the XXXIth Congress of the Turkish National Otolaryngology and Head and Neck Surgery, 28 October–1 November 2009, Antalya, Turkey. * Corresponding author. Tel.: +90 3805414107; fax: +90 3805414486. E-mail address: hyaman1975@yahoo.com (H. Yaman). Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology journal homepage: www.elsevier.com/locate/ijporl 0165-5876/$ – see front matter ß 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijporl.2009.11.035