Auris, nasus, larynx · 2025
Relationship between timing of tympanostomy tube insertion and mastoid air cell development in children with otitis media.
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Kadowaki Seiichi, Ishii Ryota, Sugiyama Tomonori, Kikuchi Saori, Iino Yukiko
Аннотация
OBJECTIVE: This study aimed to evaluate the effect of age at tympanostomy tube insertion on mastoid air cell development, focusing on whether insertion before 3 years of age is associated with more favorable pneumatization.
METHODS: We retrospectively analyzed 39 children (71 ears) who developed tympanic membrane perforation following tube insertion (tube group), including cases primarily associated with recurrent acute otitis media (rAOM) and otitis media with effusion (OME). The control group consisted of 41 children (41 ears) with congenital cholesteatoma, using their contralateral normal ears as controls. Mastoid air cell area was measured on axial temporal bone CT using two standard slices. Linear mixed-effects models were applied to assess associations with age, sex, laterality, and tube insertion age (<3 vs. ≥3 years). Age-specific comparisons between the tube and control groups were also performed.
RESULTS: The control group included 112 CT images, and the tube group included 71 images (46 with OME, 25 with rAOM). The average mastoid air cell area was 437.7 ± 181.6 mm² in the control group and 263.8 ± 139.6 mm² in the tube group. In controls, mastoid air cell area increased significantly with age (p < 0.001), while sex and laterality were not significant predictors. In the rAOM subgroup, children who underwent tube insertion before age 3 had mastoid air cell areas most similar to those of controls (e.g., age 1: p = 0.284), whereas insertion at ≥3 years was associated with significantly smaller areas across all groups (p < 0.001). No consistent age-related recovery was observed after age 3.
CONCLUSION: Tympanostomy tube insertion before 3 years of age, especially in patients with rAOM, is associated with mastoid air cell development closer to that of healthy controls. Early intervention may play a key role in preserving mastoid pneumatization and preventing chronic middle ear sequelae.
METHODS: We retrospectively analyzed 39 children (71 ears) who developed tympanic membrane perforation following tube insertion (tube group), including cases primarily associated with recurrent acute otitis media (rAOM) and otitis media with effusion (OME). The control group consisted of 41 children (41 ears) with congenital cholesteatoma, using their contralateral normal ears as controls. Mastoid air cell area was measured on axial temporal bone CT using two standard slices. Linear mixed-effects models were applied to assess associations with age, sex, laterality, and tube insertion age (<3 vs. ≥3 years). Age-specific comparisons between the tube and control groups were also performed.
RESULTS: The control group included 112 CT images, and the tube group included 71 images (46 with OME, 25 with rAOM). The average mastoid air cell area was 437.7 ± 181.6 mm² in the control group and 263.8 ± 139.6 mm² in the tube group. In controls, mastoid air cell area increased significantly with age (p < 0.001), while sex and laterality were not significant predictors. In the rAOM subgroup, children who underwent tube insertion before age 3 had mastoid air cell areas most similar to those of controls (e.g., age 1: p = 0.284), whereas insertion at ≥3 years was associated with significantly smaller areas across all groups (p < 0.001). No consistent age-related recovery was observed after age 3.
CONCLUSION: Tympanostomy tube insertion before 3 years of age, especially in patients with rAOM, is associated with mastoid air cell development closer to that of healthy controls. Early intervention may play a key role in preserving mastoid pneumatization and preventing chronic middle ear sequelae.