(1031) Healthcare Disparities, Procedural Variables, and Outcomes Following Tympanostomy Tube Removal

Introduction: This study assessed healthcare disparities in outcomes of patients following tympanostomy tube removal and identified variables contributing to persistent perforations.

Methods: This was a retrospective cohort study of patients undergoing tympanostomy tube removal between 2013 and 2023 at a tertiary pediatric medical center. A cohort of 232 patients (291 ears) was analyzed for correlations between clinical and demographic variables and performance of myringoplasty or persistent perforation.

Results: Male patients underwent more myringoplasties (OR 2.26. p = 0.015, chi square), but persistent perforation rates were similar to females (OR 0.99, p = 0.072, chi square). Older patients underwent more myringoplasties (r: 0.29, p < 0.001) and were less likely to have persistent perforations (r: -0.018, p = 0.003). There was no significant difference in rate of myringoplasty between Caucasian and African American patients (OR 2.09, p = 0.176). There were no persistent tympanic membrane perforations in African Americans while 20 (9.66%) Caucasians had perforations following tube removal. Similarly, ethnicity had no effect on myringoplasty rates (OR 2.13, p = 0.089) or persistent perforations (OR 0.73, p = 0.679). The length of time a tube was present increased the likelihood of myringoplasty (r: 0.22, p = 0.001) and persistent perforation (r: 0.35, p < 0.001). Long-term tubes increased persistent perforation rate (chi square: 13.292, p < 0.001). Myringoplasty did not result in a decreased rate of postoperative perforations (OR 0.91 p = 0.867, chi square). There were no postoperative perforations after 14 fat patch myringoplasties, while 4 of 34 synthetic myringoplasties had perforations at follow up.

Conclusions: Demographic correlates with performance of myringoplasty or persistent perforation require further study to identify clinical variables that may account for observed differences. The length of time a tympanostomy tube was present increased the likelihood of both myringoplasty and persistent perforation. Myringoplasty did not improve the rate of tympanic membrane closure.