Tympanostomy Tube Otorrhea: Microbiological Differences Between Children with and Without Cleft Palate

Objective To characterize and compare microbiological profiles in tympanostomy tube otorrhea for children with and without cleft palate. Design Retrospective cohort study. Setting Pediatric otolaryngology and multidisciplinary cleft/craniofacial clinic at a single tertiary care center. Patients Children with and without cleft palate <18 years of age who underwent tympanostomy tube placement between 2017–2021. Main outcome measures Otopathogen profiles and antibiotic resistance patterns in ear culture specimens obtained in children presenting for treatment of recalcitrant post-tympanostomy tube otorrhea. Results Of the 886 children with tympanostomy tubes placed between 2017–2021, 345 (38.9%) had clinically significant otorrhea defined as requiring at least one otolaryngology visit for treatment. Children with cleft palate had higher rates of otorrhea (50.0% versus 35.7%; P < .01). In the 128 cultures obtained, Staphylococcus aureus was the most common organism in both groups present in 39.8% of cultures; 49% were methicillin-resistant ( MRSA). Pseudomonas aeruginosa was also frequently isolated (20.0% versus 23.4%, P = .69) in children with and without cleft palate. Collectively, fluoroquinolone resistance was observed in 68.6% and 27.6% of the S. aureus and P. aeruginosa isolates, respectively, however, no differences in fluoroquinolone resistance were observed between cleft and non-cleft cohorts. Corynebacterium species were isolated more frequently in children with cleft palate (26.7% versus 6.1%, P < .01), a finding of unclear significance. Conclusions Recalcitrant post-tympanostomy tube otorrhea is more common in children with cleft palate. MRSA was the most common isolate, which was commonly resistant to first-line fluoroquinolone therapy.