Objectives

Risk factors for middle ear disease necessitating myringotomy with tympanostomy tube placement after a tracheostomy have not been thoroughly explored. This study investigates the incidence and risk factors for ear tube placement in pediatric patients with a tracheostomy.

Methods

Pediatric patients under age 18 who underwent tracheotomy between 2002 and 2010 at two institutions were identified. Patients were excluded if they had undergone myringotomy prior to, or at the same time as, the tracheotomy, or did not have at least two years of follow-up clinic visits. The presence of other comorbidities was recorded. Descriptive statistics and logistic regression models were used to assess the impact of clinical characteristics on outcomes.

Results

A total of 214 patients met inclusion criteria. Median patient age at time of tracheotomy was 6 months (IQR 2–17), median patient age at time of myringotomy with tubes was 12 months (IQR8-17), and median time between tracheotomy and myringotomy with tube placement was 8 months (IQR 5–11). Sixty-seven (31%) patients required myringotomy with tympanostomy tube placement within the first two years after tracheotomy. Fifty-eight (87%) patients who underwent myringotomy with tympanostomy tubes were younger than 2 years at the time of the procedure. Logistical regression found younger age at time of tracheotomy to be a risk factor (OR: 0.71, 95% CI: 0.5–0.9, p < 0.006). The combination of tracheostomy with gastric tube increased the risk of requiring myringotomy with tubes 2.79 fold (p < 0.009). Craniofacial abnormalities (p < 0.001), known genetic syndrome (p = 0.009), cleft palate (p < 0.001), age at time of tracheotomy (p < 0.001) and gastric tubes (p = 0.002) were all independently found to increase risk of myringotomy with tubes. Patients’ gestational age (p = 0.411), ventilator dependence (p = 0.33), and airway structural abnormalities (p = 0.632) did not increase this risk.

Conclusion

This study reports a high incidence of myringotomy with tubes in children with tracheostomy relative to the general pediatric population. Many comorbid conditions that often accompany the need for tracheotomy place these patients at a higher risk for ear disease requiring surgical intervention. Risk factors for operative middle ear disease in this population included age at time of tracheostomy, craniofacial abnormalities, and presence of a G-tube.

中文翻译：

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儿童气管切开术后前两年需要鼓膜切开术的中耳疾病

目标

气管切开术后需要鼓膜切开术并放置鼓膜造口管的中耳疾病的危险因素尚未得到彻底探讨。本研究调查了气管切开术儿科患者耳管放置的发生率和危险因素。

方法

确定了 2002 年至 2010 年在两个机构接受气管切开术的 18 岁以下儿科患者。如果患者在气管切开术之前或同时进行了鼓膜切开术，或者没有至少两年的随访门诊就诊，则将其排除在外。记录其他合并症的存在。描述性统计和逻辑回归模型用于评估临床特征对结果的影响。

结果

共有 214 名患者符合纳入标准。气管切开术时患者年龄中位数为 6 个月 (IQR 2-17)，鼓管切开术时患者年龄中位数为 12 个月 (IQR8-17)，气管切开术与放置管子鼓膜切开术之间的中位时间为 8 个月 (IQR 5-11）。67 名 (31%) 患者在气管切开后的前两年内需要鼓膜切开术并放置鼓膜造口管。58 名 (87%) 接受鼓膜切开术和鼓膜造口术的患者在手术时小于 2 岁。Logistic 回归发现气管切开时年龄较小是一个危险因素（OR：0.71，95% CI：0.5–0.9，p < 0.006）。气管切开术与胃管的组合增加了需要用管进行鼓膜切开术的风险 2.79 倍 (p < 0.009)。颅面异常（p < 0.001），已知的遗传综合征（p = 0.009）、腭裂（p < 0.001）、气管切开时的年龄（p < 0.001）和胃管（p = 0.002）都被独立发现会增加鼓膜切开术的风险。患者的胎龄 (p = 0.411)、呼吸机依赖 (p = 0.33) 和气道结构异常 (p = 0.632) 并未增加这种风险。

结论

本研究报告称，与一般儿科人群相比，气管造口术儿童使用管鼓膜切开术的发生率较高。许多伴随需要进行气管切开术的合并症使这些患者面临需要手术干预的耳部疾病的更高风险。该人群中手术中耳疾病的危险因素包括气管切开术时的年龄、颅面畸形和 G 管的存在。