title: Strategies to prevent biofilm-based tympanostomy tube infections.
abstract: OBJECTIVE
  To review the potential contributory role of biofilms to post-tympanstomy tube otorrhea and plugging as well as the available interventions currently utilized to prevent biofilm formation on tympanostomy tubes.
  
  
  METHODS
  A literature review was performed utilizing the MEDLINE/Pubmed database from 1980 to 2013.
  
  
  METHODS
  Electronic database was searched with combinations of keywords "biofilm", "tympanostomy tube", "ventilation tube", and "post-tympanostomy tube otorrhea".
  
  
  RESULTS
  Two of the most common sequelae that occur after tympanostomy tube insertion are otorrhea and tube occlusion. There is an increased evidence supporting a role for biofilms in the pathogenesis of otitis media. In this review, we have shown a multitude of novel approaches for prevention of biofilm associated sequelae of otitis media with effusion. These interventions include (i) changing the inherent composition of the tube itself, (ii) coating the tubes with antibiotics, polymers, plant extracts, or other biofilm-resistant materials, (iii) tubal impregnation with antimicrobial compounds, and (iv) surface alterations of the tube by ion-bombardment or surface ionization.
  
  
  CONCLUSIONS
  Currently, there is not one type of tympanostomy tube in which bacteria will not adhere. The challenges of treating chronic post-tympanostomy tube otorrhea and tube occlusion indicate the need for further research in optimization of tympanostomy tube design in addition to development of novel therapies.
authors: School of Medicine, Texas Tech University Health Sciences Center, 3601 4th Street STOP 8312, Lubbock, TX 79430, USA. Electronic address: J.Wang@ttuhsc.edu.
authors: James C
authors: JC
authors: Wang
authors: Department of Microbiology & Infectious Diseases, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
authors: Abdul N
authors: AN
authors: Hamood
authors: School of Medicine, Texas Tech University Health Sciences Center, 3601 4th Street STOP 8312, Lubbock, TX 79430, USA.
authors: Charles
authors: C
authors: Saadeh
authors: Department of Otolaryngology and Communication Enhancement, Children's Hospital Boston, Boston, MA, USA.
authors: Michael J
authors: MJ
authors: Cunningham
authors: Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.
authors: Michael T
authors: MT
authors: Yim
authors: Division of Otolaryngology, Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
authors: Joehassin
authors: J
authors: Cordero
mesh_terms: D000818:Animals; D000890:Anti-Infective Agents / Q000627:therapeutic use; D018441:Biofilms / Q000254:growth & development*; D020099:Coated Materials, Biocompatible; D004866:Equipment Contamination / Q000517:prevention & control*; D005064:Eustachian Tube / Q000382:microbiology*; D006801:Humans; D008876:Middle Ear Ventilation / Q000295:instrumentation*; D010034:Otitis Media with Effusion / Q000382:microbiology*
chemical_list: D000890:Anti-Infective Agents; D020099:Coated Materials, Biocompatible
keywords: Antimicrobial agents; Bacterial biofilms; Medical device coatings; Otitis media; Tympanostomy tubes