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Early post-tympanostomy otorrhea in children under 17 months of age.

A total number of 281 consecutive children with recurrent acute otitis media (RAOM) or otitis media with effusion (OME) was treated with ventilation tubes (VT), inserted under local anesthesia. Patients were prospectively followed-up for post-tympanostomy otorrhea, classified as "early" if observed within 7 days of the tympanostomy procedure. The age of children ranged from 5 to 16 months (average 10.1 months). VT were placed bilaterally in 279 of 281 children. The average length of otitis media (OM) history prior to tympanostomy was 3.4 months. An episode of OM had been diagnosed 1-2 times in 18.9%, 3-4 times in 68.0%, and at least 5 times in 13.1% of the children. Middle ear effusion (MEE), most often classified as mucoid was present in 65.8% of the ears. Cultures were positive for bacteria in 41 of the 185 ears with MEE (22.2%). The mastoid air cell system was radiographically normal in 9.6% and markedly clouded in 56.6%. Early post-tympanostomy otorrhea was observed in 16.0% of ears, occurring more often when MEE, especially mucopurulent, was present at tympanostomy (p < 0.01). The risk of otorrhea was significantly increased by a positive culture for pathogenic bacteria in MEE (p < 0.01) and highly significantly by the advanced opacification of the mastoid air cell system (p < 0.001). It is concluded that early post-tympanostomy otorrhea in young children is caused by the advanced infectious process in the middle ear cleft, including mastoid cell system rather than by the tympanostomy procedure itself. It may indicate the need for more active treatment in this age group.