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Clinical predictors of multiple tympanostomy tube placements in Ontario children


Objectives — To characterize risk factors that predict the need for multiple tympanostomy tube (TT) procedures.

Study Design — Retrospective population-based cohort study of children aged 18 years and younger in Ontario, Canada, who underwent at least one TT placement between January 1, 1994, and October 31, 2013.

Methods — The relative risk (RR) of need for multiple TT procedures was determined using log-binomial regression.

Results — There were 193,880 children who underwent TT insertion included in this cohort. Of these, 28.58% underwent at least two separate TT procedures. Over time, the RR of undergoing multiple TT procedures is decreasing for all children. In general, the younger the child was at the first TT procedure, the more likely the child was to undergo multiple TT procedures. Significantly higher RR for multiple TT procedures also was associated with male sex, the second-highest neighborhood income quintile, asthma or reactive airways, gastrointestinal disease, prematurity, or cleft lip and/or palate. Significantly lower RR for multiple TT procedures was associated with adenoidectomy or tonsillectomy (with or without adenoidectomy) at first TT placement or within 3 years prior. Furthermore, the benefit of adjuvant adenoidectomy or tonsillectomy was present for children aged under 4 years, in addition to those aged 4 years and older.

Conclusion — Among Ontario children who have had TT placement, more than one in four will have multiple sets placed. These identified risk factors permit improved preoperative counseling and enable identification of children who need closer follow-up.



Beyea JA, Nguyen P, Hall SF Laryngoscope. 2018; 128(4):991-7. Epub 2017 Sep 12.

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