Effects of thrombolytic agents on tympanostomy tubes occluded by blood clots

Michael I. Orestes, Bader Fileta, Snezana Haymes, Scott E. Brietzke*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective: To investigate the efficacy of various topical applications in opening a clotted tympanostomy tube (TT) using an in vitro model. Design: In vitro clinical trial. Interventions: Fresh human blood was allowed to clot in the lumen of TTs. Seven agents were tested: 0.9% saline (control), 1-mg/mL alteplase, 100-U/mL unfractionated heparin,3%hydrogen peroxide (H 2O 2),3%acetic acid, 5% acetic acid, and a mixture of 3% H 2O 2 and 3% acetic acid. Each agent was added twice a day for 14 days to TTs that were incubated and humidified to simulate ear canal conditions. The tubes were analyzed with binocular microscopy to determine the status of the obstruction. Results: A total of 16 trials per agent, including a saline control, were performed. The saline control, alteplase, and heparin failed to open any TTs in any of the trials. Compared with the control, H 2O 2 also was not effective (P=.23). Acetic acid was increasingly effective, with a 3% concentration completely clearing 5 of 16 tubes and a 5% concentration completely clearing 11 of 16 tubes (P=.006). The addition of 3% H 2O 2 to 3% acetic acid did not significantly increase clearance (P=.21). Conclusions: Thrombolytic agents and H2O2 were not effective in resolving TTs that were clotted with blood in an in vitro environment simulating the ear canal. Increasing concentrations of acetic acid are increasingly effective in this capacity.

Original languageEnglish
Pages (from-to)1228-1231
Number of pages4
JournalArchives of Otolaryngology - Head and Neck Surgery
Issue number12
StatePublished - Dec 2011
Externally publishedYes


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