Post–tympanostomy tube otorrhea: A meta-analysis

Introduction

Post–tympanostomy tube otorrhea is the most common complication of tympanostomy tube placement. The incidence of this problem varies from 3.4% to 74%. Trials that study post–tympanostomy tube otorrhea may involve valid randomization “by patient” or “by ear.” In an attempt to define “best practice,” we conduct a meta-analysis to quantify the benefit of using topical prophylactic antibiotic drops in the postoperative period. We then compare our findings with previous results found in the literature.

Methods

We selected randomized studies for which antibiotic drops had been used for at least 48 hours after tympanostomy tube insertion. Nine studies, 3 “by ear” and 6 “by patient,” met our inclusion criteria. The odds ratio and 95% confidence intervals were calculated for each to conduct the meta-analysis.

Results

Overall, prophylaxis appears to be effective at reducing the incidence of post–tympanostomy tube otorrhea. The odds ratios for all studies were less than 1.0. However, none of the 3 “by ear” studies and only 3 of the 6 “by patient” studies were statistically significant. The mean odds ratio was 52%, suggesting that prophylaxis may reduce the incidence of post–tympanostomy tube otorrhea by half.

Conclusion

This meta-analysis suggests that routine post–tympanostomy tube prophylaxis is beneficial, but this finding is dependent on selection criteria used.

EBM rating: A-1a