Refractory tympanostomy tube otorrhea: Outcomes with otowick placement

Objective: To evaluate rates of resolution of and antibiotic use in refractory otorrhea (otorrhea >= 2 weeks with no more than 2 days of otorrhea resolution during the episode) with otowick placement in comparison to medical therapy and tube removals with or without replacements.Study design: Retrospective cohort study of pediatric patients with a history of tympanostomy tube placement and refractory otorrhea between 2017 and 2022.Setting: Cleveland Clinic Foundation (CCF) pediatric otolaryngology group.Methods: Demographic data (sex, race, and age at tympanostomy tube placement) were collected. Outcome measures included number of oral and topical antibiotic treatments, duration of otorrhea episode, and resolution of otorrhea at 1 and 3 months follow-up. Wilcoxon rank sum and Kruskal-Wallis tests were used to compare number of antibiotics treatments. An ANOVA test and linear regression model using log-transformed data were used to compare duration of otorrhea. Fisher's exact test was used to compare rates of otorrhea recurrence.Results: 70 patients met inclusion criteria: 37 male (52.9%), 33 female (47.1%), with an average age at tube placement of 29.66 months. There was a statistically significant decrease in total duration of otorrhea (in days) with otowicks (17.29 +/- 13.13), compared to patients receiving medical therapy (27.09 +/- 22.02) and tube re-movals and replacements (29.63 +/- 19.95) (p = 0.025). There was no significant difference between the follow-up rates of resolution at 1 month (p = 1) and 3 months (p = 0.12).Conclusion: Otowick use is associated with shorter duration of otorrhea and can be considered as a first-line treatment for refractory otorrhea. Otowicks and medical therapy alone can reduce need for tube removals and the associated risk of anesthesia.