Tympanostomy tubes

Viscous middle ear effusions caused by allergy or irritant exposure may contribute to impaired mucociliary clearance and AOM in susceptible individuals.4 OME occurs chronically in atopic children, and effusion can persist for months after an episode of AOM. Children with chronic OME usually require tympanostomy tube placement to reduce complications such as hearing and speech impairment and recurrent otitis media. 

Other nondrug approaches include the use of external heat or cold to reduce postauricular pain and surgery. Tympanostomy tubes are most useful for patients with recurrent disease or chronic OME with impaired hearing or speech. Adenoidectomy may be necessary for children with chronic nasal obstruction, but tonsillectomy is rarely indicated. 

Tympanostomy tube A small plastic or metal tube inserted in the eardrum to keep the middle ear aerated and improve hearing in patients with chronic middle ear effusion. 

Surgical insertion of tympanostomy tubes (T tubes) is an effective method for the prevention of recurrent otitis media. 

An intact t5mipanic membrane protects the normal sterile middle ear space from bacterial pathogens. A ruptured tympanic membrane or tympanostomy tube allows external bacteria access to the middle ear space. 

Chronic suppurative otitis media is an inflammatory condition of the middle ear. The presence of a tympanic membrane perforation or a tympanostomy tube allows drainage into the external ear canal. Increased vascularity of the mucosa and submucosa, combined with acute and chronic inflammatory cells, is its hallmark. Granulation tissue, fibrosis, and osteoneogenesis are also commonly present. The granulation tissue contains neutrophils and plasma cells associated with small blood vessels and fibroblasts. ... 

Gentamicin ear-drops can cause serious adverse effects (for example vertigo, imbalance, ataxia, oscillating vision, hearing loss, and tinnitus) when they are used by patients with perforated tympanic membranes or tympanostomy tubes (8). 

Goldblatt EL, Dohar J, Nozza RJ, Nielsen RW, Goldberg T, Sidman JD, Seidlin M. Topical ofloxacin versus systemic amoxicillin/clavulanate in purulent otorrhea in children with tympanostomy tubes. Int J Pediatr Otorhinolaryngol 1998 46(1-2) 91-101. 

The safety and efficacy of topical ofloxacin ear-drops 0.3% (0.25 ml bd) have been compared with that of co-amoxiclav oral suspension (40 mg/kg/day) for acute otitis media in 286 children aged 1-12 years with tympanostomy tubes in place. Topical ofloxacin was as effective as and better tolerated than systemic therapy with co-amoxiclav. Treatment-related adverse event rates were 31% for co-amoxiclav and 6% for ofloxacin (1). 

Tympanostomy tube insertion Gastrointestinal tract Transesophageal echocardiography ... 

Ofloxacin interferes with microbial DNA synthesis. It is indicated in the treatment of acnte bacterial exacerbations of chronic bronchitis, commnnity acquired pneumonia, uncomplicated skin and skin structure infections, acute uncomplicated urethral and cervical gonorrhea, nongonococcal urethritis, cervicitis, acute pelvic inflammatory disease, uncomplicated cystitis, complicated urinary tract infections (UTI), and prostatitis cdiV eAhy Escherichia coli. Ophthalmic use for treatment of conjunctivitis and corneal ulcer infections caused by susceptible organisms otic use for treatment of otitis externa, chronic suppurative otitis media in patients with perforated tympanic membranes, and acute otitis media in pediatric patients with tympanostomy tubes. 

This is the most appropriate response. A myringotomy with insertion of tympanostomy tubes is performed on children with persistent ear infections despite antibiotic therapy or otitis media with effusion for more than 3 months with associated hearing loss. 

Viscosity is to be considered when using topical agents [10]. Theoretically, the more viscous a preparation, the more difficult it will pass through a tympanostomy tube or a drum perforation and enter the middle ear. A higher viscosity could also help to prevent ear drops flowing from the auditory canal. 

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