Colleras obstruidas: ¿Qué hacer?: un modelo experimental ex vivo / Clearing blocked tympanostomy tubes: an ex-vivo model

Introducción: La obstrucción del lumen de las colleras es un evento infrecuente, pero que anula la efectividad del dispositivo en la ventilación del oído medio. Existen múltiples opciones de tratamiento tópico para esta situación clínica, sin embargo, los reportes en la literatura al respecto presentan resultados contradictorios. Objetivos: Analizar la efectividad de distintos tratamientos tópicos para destapar una collera ocluida con coágulo de sangre. Material y método: Modelo experimental ex vivo, 184 tubos de ventilación obstruidos con coágulo de sangre. Tratamiento tópico, 8 grupos experimentales (agua oxigenada 3 por ciento, ácido acético 5 por ciento, ciprofloxacino 0,3 por ciento, vinagre de mesa, heparina, mezcla de H2O2/acetato 1:1, suero fisiológico 0.9 por ciento) y 2 grupos control (sin tratamiento). Revisión de permeabilidad de lumen de colleras a los 3, 7 y 10 días. Resultados: El agua oxigenada (H2O2) resulta ser el tratamiento más efectivo (88 por ciento y 92 por ciento de efectividad a los 7 y 10 días). Ciprofloxacino, vinagre de mesa, suero fisiológico y heparina son inefectivos, sin diferencias significativas con grupo control. Ciprofloxacino y suero fisiológico sedimentan más, e incluso tapan colleras previamente permeables. Conclusiones: H2O2 es un tratamiento seguro, efectivo y económico para destapar colleras obstruidas con coágulos de sangre.

Introduction: Blocked tympanostomy tubes (TT) are an uncommon event, but avoids the effectiveness of this device in middle ear ventilation. Many topical treatment options are available for this clinical situation, however, reports in literature show conflicting results. Aim: Analyze the effectiveness of various topical treatments to open blood clot blocked TT. Material and Method: Ex vivo experimental model. 184 blood clot blocked TT. Topical treatment, 8 experimental groups (3 percent hydrogen peroxide, 5 percent acetic acid, 0,3 percent ciprofloxacin, vinegar, heparin, mixture 1:1 H2O2/acetate, 0.9 percent saline) and 2 control group (no treatment). Review of tube permeability at 3, 7 and 10 days of treatment. Results: H2O2 is the most effective treatment (88 percent & 92 percent effectiveness at 7 & 10 days). Ciprofloxacin, vinegar, saline and heparin are ineffective, with no statistical differences with control group. Ciprofloxacin and saline even blocked previously opened TT. Conclusions: H2O2 is a safe, effective and economic treatment to clear blood clot blocked TT.

Effectiveness of adenoidectomy on tympanostomy tubes retention duration

The children with middle ear effusion need repeated re-tympanostomies. Adenoidectomy is an effective surgical intervention in the management of chronic otitis media with effusion in conjunction with insertion of tympanostomy tubes [TTs]. To find out whether TTs in different positions decrease the rate of re-tympanostomies study was done. The present study retrospectively evaluated the effectiveness of adenoidectomy on retention of Shepard TTs in antero-inferior quadrant [AIQ] and postero-inferior quadrant [PIQ] with chronic, persistent or recurrent otitis media. Eighty-five children [one-hundred and seventy ears] underwent bilateral myringotomy and TTs placement with and without adenoidectomy with informed consent. According to the TTs retention duration rate, there was a significant difference between adenoidectomy and non-adenoidectomy groups in AIQ. It was concluded that TTs placement in the AIQ in conjunction with adenoidectomy showed better improvement and prolonged ventilation. This study suggests that adenoidectomy is an effective surgical intervention in the management of otitis media especially when it is performed in conjunction with insertion of TTs. This significantly decreases tube extrusion rate especially in an AIQ, which might be due to improving eustachian tube function that consequently reduces repeated otitis media