title: Can head position after anesthesia cause occlusion of the tympanostomy tube?
abstract: OBJECTIVE
  Owing to anecdotal evidence, in bilateral tympanostomy, there is a risk of tube occlusion in the ear that stays superior during the recovery after anesthesia. This observational analysis was designed to evaluate the side difference of tympanostomy tube occlusions owing to head position during the operation and postoperative recovery. It was part of a prospective clinical trial with bilateral tympanostomy tube insertion that was conducted to evaluate the effect of albumin coating tympanostomy tube sequelae.
  
  
  METHODS
  In the bilateral tympanostomy, the right ear was always operated on first. After left ear tube insertion and during the recovery phase after anesthesia, the patient was turned to lie on the right side. The number of tube sequelae were studied during a 9-month follow-up period.
  
  
  RESULTS
  At the first 1-month follow-up visit, 7 right ear tubes and 18 left ear tubes had occluded (p = .043). The same tendency was seen throughout the follow-up. Also, according to a survival analysis, in which survival functions according to laterality were compared using the log-rank test, stratified by tube coating, the left tube occluded at a significantly higher rate.
  
  
  CONCLUSIONS
  The position of the patient's head when awake after anesthesia may have an influence on tube occlusion. In this study, the tube located superiorly was occluded more often. This tendency remained during the follow-up. We concluded that there is a possible association between the position of the head during early recovery and occlusion of the tympanostomy tube.
authors.affiliation: of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Teemu J
authors.initials: TJ
authors.lastname: Kinnari
authors.forename: Antti A
authors.initials: AA
authors.lastname: Aarnisalo
authors.forename: Heikki
authors.initials: H
authors.lastname: Rihkanen
authors.forename: Johan
authors.initials: J
authors.lastname: Lundin
authors.forename: Jussi
authors.initials: J
authors.lastname: Jero
mesh_terms: D000768:Anesthesia, General; D004868:Equipment Failure; D006257:Head; D006801:Humans; D008876:Middle Ear Ventilation / Q000379:methods* / Q000706:statistics & numerical data*; D011182:Postoperative Care; D011187:Posture