Evaluating Adverse Outcomes After Myringotomy and Tube Placement in Head and Neck Cancer

Monday, September 30, 2024

10:06 AM – 10:12 AM EDT

Location: MBCC, 231

Disclosure(s):

Krithika Kuppusamy, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Kevin Wong, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Steven J. Eliades, MD, PhD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Jason A. Brant, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Describe and evaluate the rates of adverse outcomes among patients with or without history of head and neck (HN) cancer undergoing myringotomy and tube placement (MT) for middle ear effusion.

Methods: Retrospective chart review of adult patients undergoing MT for middle ear effusion at our institution (2018-2022). Data on demographics, cancer diagnosis and treatment, physical exam, audiometry, and clinical course were collected. Adverse outcomes were persistent perforation and persistent effusion with/without repeat MT at last follow-up. Multivariate regression analysis was done in the overall and cancer cohorts. Nearest-neighbor propensity score matching was performed to further compare adverse outcome rates in a matched non-cancer cohort.

Results: 578 patients (736 ears) were studied with a mean follow up of 38 months, including 84 (14.53%) in the cancer cohort, of which 78 had primary HN neoplasms and 67 received HN radiation. On average, cancer patients were older than non-cancer (NC) patients (67.5 vs 63.3 years, p < 0.05). HN cancer patients had similar rates of overall adverse outcomes (45.24% vs 46.96%, p = 0.86). Rates of persistent perforation were higher among cancer patients (10.71% vs 2.42%, p < 0.001); there was no significant difference in rates of persistent effusion (34.52% vs 44.53%; p = 0.11). On multivariate regression, no individual variable had higher odds of any adverse outcome, including need for free flap reconstruction and cancer subsite. Post propensity score matching, perforation rates remained higher in the cancer cohort but did not reach statistical significance (10.71% vs 3.57%, p = 0.13). There was no difference in rate of adverse events for overall events (45.24% vs 38.10%, p = 0.43) or persistent effusion (34.52% vs 34.52%, p = 1.0).

Conclusions: Patients with a history of HN cancer or radiation have a three-to-five-fold risk of persistent TM perforation after MT, but no increased risk of persistent effusion. On multivariate analysis, no single variable of interest was a significant predictor of perforation, but these findings may reflect overall low prevalence in our cohort.

Presenting Author(s)

Krithika Kuppusamy, BS

Medical Student
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

CY

Carly Y. Yang

Undergraduate
University of Pennsylvania
San Diego, CA, United States

Disclosure information not submitted.
SV

Swar Vimawala, MD

Cooper University Healthcare, United States

Disclosure information not submitted.
Kevin Wong, MD

Otology/Neurotology Fellow
University of Pennsylvania Health System
Philadelphia, Pennsylvania, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Steven J. Eliades, MD, PhD

Associate Professor
Duke University School of Medicine
Durham, NC, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
JB

Jason A. Brant, MD

Associate Professor
University of Wisconsin
Middleton, WI, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Tiffany P. Hwa, MD

Assistant Professor
Division of Otology, Neurotology, & Lateral Skull Base Surgery, University of Pennsylvania Health System
Princeton Junction, NJ, United States

Disclosure information not submitted.