Epidemiology of Persistent Tympanic Membrane Perforations Subsequent to Tympanostomy Tubes Assessed With Real World Data

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To quantify the incidence of persistent tympanic membrane perforation (TMP) after tympanostomy tube (TT) surgery using a large population-based cohort.

Study Design:

A retrospective cohort study.


Medicaid claims data from 1999 to 2006.


We studied healthy children who had Medicaid eligibility within 6 months of birth that received TTs and had 2 to 7 years of follow-up.

Main Outcome Measures:

We operationalized persistent TMP by a charge for tympanoplasty and/or one or more diagnoses of TMP.


We identified 47,724 children who received TTs and had ≥2 years eligibility. The incidence of persistent TMP varied, based on definition and follow-up. The 2 and 7-year TMP rates were: 0.38% and 3.81% for two TMP diagnoses 6 months apart or tympanoplasty; 0.26% and 2.94% for two TMP diagnoses 6 months apart; 0.13% and 1.73% for tympanoplasty, alone; 0.04% and 1.21% for tympanoplasty preceded by one TMP diagnosis; and 0.01% and 0.52% for tympanoplasty and two TMP diagnoses 6 months apart. Reinserting TTs was associated with an increased likelihood of persistent TMP (adjusted hazard ratio [HR] = 1.98, 95% CI 1.49–2.63). Each year increase in age was associated with 49% increase in the risk of persistent TMP.


Billing claims data may be used to assess the rate of persistent TMP after TT placement in large populations, yielding results consistent with findings from cohort studies and meta-analyses. Our findings may serve as the basis for future TMP research using real world datasets.

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