Overall Effectiveness of Tympanostomy Tube Placement as Treatment of Otitis Media

Otitis media is currently one of the most common reasons why children under the age of 15 visit a pediatrician (Mui et al., 2005). Since the disease causes physical discomfort of a relatively high degree and mainly affects young children who have low tolerance for such discomfort, it is not unusual for patients suffering from otitis media to visit a health care practitioner over eight times a year, on average, regarding the disease (Mui et al., 2005). Treatment using antibiotics is time consuming, produces numerous side effects, especially for the patient's digestive system, and has relatively low levels of efficacy for the long term (Ketelslagers, 2007). As an alternative, myringotomy with insertion of tympanostomy tube - or tubes - continues to be the most common method of treating otitis media with middle ear effusion (OME) (Diacova, 2007). This procedure generally reduces the chance of the patient developing a cholesteatoma, but in those cases where a single surgery is ineffective and additional ones are needed, repeated placement of tympanotomy tubes actually may increase the risk of developing a cholesteatoma, retractions pockets, or tympanic membrane perforation (Diacova, 2007). To determine the overall effectiveness of tympanostomy tube placement as treatment for otitis media, therefore, a slew of factors need to be considered, including the risk of recurrence and quality-of-life improvements in patients undergoing the procedure. Since the disease affects young children, quality-of-life levels for their parents, guardians, or other caregivers must be considered as well.

Diacova & McDonald (2007) conducted an evaluative study of 183 patients (involving 197 ears) who have undergone either tympanostomy tube insertion or conservative treatment for their OME, with the goal of determining the post-treatment progression of the disease. The study sample was comprised of the charts of the patients who all have undergone surgery for chronic otitis media (COM).

The researchers found a higher occurrence of retraction pockets in patients who have undergone tympanostomy tube placement, but these pockets were significantly less severe than those that developed in conservatively treated ears and generally did not require additional intervention for a longer period of time. Similarly, tympanostomy-treated ears were much less likely to develop cholesteatomas than those treated conservatively. Finally, even though all cases participating in the study required surgery for COM, the tympanostomy-treated ears required significantly fewer repeat surgeries than those ears that were treated conservatively.

The conclusion of this study was that tympanostomy tube insertion represented the superior treatment of otitis media than the conservative treatment approach. Its most important advantage was that patients treated with tympanostomy tube placement did not require radical surgery as often as patients treated conservatively.

While Diacova & McDonald's (2007) study showed the advantages of tympanostomy tubes in terms of recurrence of otitis media in patients, they did not touch on the actual physical improvements for patients or the length of time these improvements lasted after the procedure. Ketelslagers et al. (2007) conducted a study to this regard, in which they examined 29 patients that had undergone the procedure, with the initial evaluation immediately post-surgery and the follow-up taking place anywhere between 16 months and 10.5 years later.

The study found that the procedure allowed the patients to maintain a safe, dry, and self-cleaning ear for an average of 4.75 years following the procedure. Improvements in hearing were not as pronounced without the implementation of a hearing aid.

The conclusion stemming from this study was that surgical intervention like tympanostomy tube insertion was a viable option in treating even the severe cases of otitis media. The procedure also produced improvements over the relatively long period of time and without requiring further treatment.

While tympanostomy tube placement might not improve the otitis media patient's hearing significantly, there are other aspects of the disease that affect the patient's quality of life. This results in frequent doctor visits and, since the patient is usually a young child, affects caregivers as much as patients themselves. Mui et al. (2005) examined the changes in quality of life for otitis media patients younger than 18 years of age, who had undergone tympanostomy tube placement, and for their parents or caregivers. The study utilized chart analysis for the patients and a telephone survey for parents/caregivers.

The results showed a significant drop in clinic visits and antibiotic prescriptions for otitis media patients following the tympanostomy tube placement procedure. While only about one-quarter of all patients received both pre- and postoperative audiograms, 86% of them showed hearing improvement following the surgery. Among parents and caregivers, over 90% reported improvements in their quality of life and reduction in burden of caring for a child afflicted with otitis media following the surgery.

Based on these results, the researchers concluding that tympanostomy tube placement results in significant quality-of-life improvement for both patients and their caregivers. Additionally, they cited the reduced number of doctor office visits and antibiotic prescriptions as an indication of the procedure's cost-effectiveness.

The presented data provides a fair explanation why tympanostomy tube placement is one of the most commonly used treatments of otitis media today. It produces better recovery, less reoccurrence, and improves the quality of life for both patients and their caregivers. Still, a significant number of medical practitioners prescribe antibiotics as the initial treatment approach. In the managed care environment, such practice is economically acceptable since antibiotic treatment is generally less expensive than surgical intervention (Mui, 2005). Additional studies are necessary to evaluate closely the cost-effectiveness of tympanostomy tube placement in comparison to the cost-effectiveness of antibiotic treatments. Only when the financial aspects are taken under consideration can the overall effectiveness of this treatment approach be accurately determined.

REFERENCES
Diacova, S., & McDonald, T. J. (2007). A comparison of outcomes following tympanostomy tube placement or conservative measures for management of otitis media with effusion. Ear, Nose & Throat Journal, 9, 552-554.
Ketelslagers, K., Somers, T., De Foer, B., Zarowski, A., & Offeciers, E. (2007). Results, hearing rehabilitation, and follow-up with magnetic resonance imaging after tympanomastoid exenteration, obliteration, and external canal overclosure for severe chronic otitis media. Annals of Otology, Rhinology & Laryngology, 116, 705-711.
Mui, S., Rasgon, B. M., Hilsinger, R. L., Lewis, B., & Lactao, G. (2005). Tympanostomy tubes for otitis media: Quality-of-life improvement for children and patients. Ear, Nose & Throat Journal, 6, 418-424.