Incidence of and risk factors for additional tympanostomy tube insertion in children

Objective: To determine the incidence and risk factors that account for additional tympanostomy tube placement among children who have undergone an initial placement of ventilation tubes. Design: Retrospective case review of consecutive patients. Setting: A tertiary care pediatric hospital. Patients: Five-year consecutive series of 2121 children cared for in a hospital-based, tertiary care pediatric otolaryngology practice. Intervention: Subsequent need for additional ventilation tube surgery. Results: Four hundred twenty-three (19.9%) of the 2121 children who underwent initial placement of bilateral myringotomy tubes (BMTs) between April 20, 1995, and May 25, 1998, subsequently had a second set of tubes placed by May 25, 2000. Children 18 months or younger at the time of initial BMT placement were nearly twice as likely (26.3% vs 15.9%) to undergo a second BMT procedure when compared with children who were older than 18 months at initial surgery (P<.005). The probability of having a second BMT procedure was reduced if adenoidectomy was performed at the first BMT procedure (0.08 vs 0.24, P<.001). Adenoidectomy status, craniofacial deformities, and a family history of adenoidectomy or tonsillectomy with or without BMTs were independent risk factors for multiple BMTs. Conclusions: Epidemiologic analysis of this consecutive series of patients who underwent BMT placement in a tertiary care pediatric otolaryngology practice suggests that I in 5 patients will subsequently require a second set of ventilation tubes. Age younger than 18 months at the time of the initial BMT procedure is associated with an increased risk for additional surgery but is not an independent risk factor. Adenoidectomy reduces the incidence of subsequent BMTs following initial surgery.