Dr. Scott Manning: Estimates of the incidence of post-tympanostomy tube otorrhea (PTTO) vary widely, but a range of 16 to 30% seems likely. (1-3) The incidence of recurrent PTTO ([greater than or equal to]3 episodes) is 7 to 15%, and the incidence of persistent PTTO (3 wk) is 3 to 4%. (2,3) Drainage during the immediate postoperative period is not considered to constitute PTTO. Rosenfeld et al showed in a quality-of-life study that PTTO certainly has a deleterious effect on parents' satisfaction with their child's care. (4) Etiologic factors in PTTO are viral illness and acute otitis media (AOM). Ruohola et al found that in children younger than 6 years of age, PTTO was almost always preceded by an upper respiratory infection. (5) Two prospective studies suggest that swimming does not appear to be a cause of PTTO, and that earplugs conferred a very small benefit in terms of preventing PTTO in swimmers. (6,7) The results of perioperative antibiotic administration for PTTO prophylaxis have been mixed. Nawasreh and Al-Wedyan in Saudi Arabia found that perioperative ciprofloxacin drops lowered the rate of postoperative otorrhea from 16 to 8%, (8) but other studies have indicated that the benefit of topical antibiotic prophylaxis in general is small. (9) Other uncommon causes are allergy" and perhaps biofilms, (11,12) which we will cover later in this discussion.
