Recurrent tube insertion for chronic otitis media with effusion in children over 6 years

Adenoid enlargement has traditionally been considered a factor in otitis media; adenoid size, however, does not appear to be correlated with otitis media occurrence. Presence of pathogenic bacteria in the adenoids of children with otitis media has been shown, and adenoidectomy appears to affect the middle ear primarily by removal of the source of infection in the nasopharynx. Three recent randomized, controlled studies showed the efficacy of adenoidectomy in the treatment of chronic secretory otitis media. In one study comparing no treatment, adenoidectomy, and adenotonsillectomy, a significant benefit was seen with adenoidectomy that was not enhanced by tonsillectomy. Another study that compared adenoidectomy, tympanostomy tubes, and a combination of the two showed a significant reduction in effusion time and less surgical retreatment over 2 years in the two adenoidectomy groups. The third study demonstrated the effect of adenoidectomy in children with recurrent chronic otitis media with effusion after failure of tympanostomy tube insertion. All three studies showed that the effect of adenoidectomy was independent of adenoid size. This review discusses current concepts of adenoid physiology and pathology, the major adenoidectomy studies, and indications for the procedure.

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Identification of Hearing Loss in Children with Otitis Media

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894941030s516 ◽

1994 ◽

Vol 103 (5_suppl) ◽

pp. 59-61 ◽

Cited By ~ 27

Author(s):

Lisa L. Hunter ◽

Robert H. Margolis ◽

G. Scott Giebink

Keyword(s):

Hearing Loss ◽

Otitis Media ◽

Otitis Media With Effusion ◽

Chronic Otitis Media ◽

Tympanostomy Tube ◽

Common Complication ◽

Tube Insertion ◽

Prospective Longitudinal Study ◽

Hearing Status ◽

Prospective Longitudinal

Hearing loss is the most common complication of otitis media. Hearing loss secondary to otitis media has increasingly been associated with significant developmental and educational problems. However, not enough is known about the peripheral auditory effects of otitis media. The young age of most children affected by otitis media makes detailed audiologic assessment challenging. This paper presents a brief synopsis of audiologic strategies that may be employed to assess the hearing status of infants and children with otitis media with effusion. Data pertaining to the risk of hearing loss recurrence after tympanostomy tube insertion are presented from a prospective longitudinal study of hearing in children with chronic otitis media with effusion.

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Recurrent Tympanostomy Tube Insertion for Chronic Otitis Media with Effusion in Children and the Effect of Concurrent Adenoidectomy on the Outcome.

Saudi Journal of Otorhinolaryngology Head and Neck Surgery ◽

10.4103/1319-8491.273923 ◽

2018 ◽

Vol 20 (2) ◽

pp. 62

Author(s):

Abdulmonem Al-Shaikh ◽

Rawan Mandura ◽

Ola Bafail

Keyword(s):

Otitis Media ◽

Otitis Media With Effusion ◽

Chronic Otitis Media ◽

Tympanostomy Tube ◽

Tube Insertion

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Grommets - an update on common indications for tympanostomy tube placement

South African Family Practice ◽

10.4102/safp.v59i3.4684 ◽

2017 ◽

Vol 59 (3) ◽

pp. 13-16

Author(s):

Kim Outhoff

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Acute Otitis Media ◽

Chronic Otitis Media ◽

Tube Placement ◽

Tympanostomy Tube ◽

Tube Insertion ◽

Tube Lumen ◽

Increased Risk

Children younger than 7 years are at increased risk of otitis media because of their immature immune systems and poorly functioning eustachian tubes that normally ventilate the middle ear space and equalize pressure with the external environment. More than 80% of children have at least one episode of acute otitis media (AOM) before the age of 3 years and 40% experience six or more recurrences by the time they are 7 years old.1 By the age of 3 years, approximately 7% of children undergo surgery for tympanostomy tube insertion for a range of otitis media issues, most commonly for chronic otitis media with effusion (OME), recurrent acute AOM, and acute otitis media that persists despite antibiotic therapy.2 However, tympanostomy tube insertion is associated with risks and remains a controversial practice especially in children with OME of less than three months’ duration and in children with recurrent AOM. Adverse effects associated with tympanostomy tube insertion include those associated with anaesthesia and its complications (laryngospasm, bronchospasm), as well as tube related sequelae such as recurrent (7%) or persistent (16–26%) otorrhoea, blockage of the tube lumen (7%), granulation tissue (4%), premature extrusion of the tube (4%), tympanostomy tube displacement into the middle ear (0.5%) and persistent perforation of the tympanic membrane (1%–6%).3 This article offers guidance for family practitioners wishing to optimize health outcomes in children potentially requiring tympanostomy tube placement.

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Tympanostomy Tube Complication in Otitis Media with Effusion

AL-Kindy College Medical Journal ◽

10.47723/kcmj.v15i2.163 ◽

2020 ◽

Vol 15 (2) ◽

pp. 58-61

Author(s):

Ghassan Hassan Rahim

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Chronic Otitis Media ◽

Tympanostomy Tube ◽

Middle Ear Effusion ◽

Tube Insertion ◽

Patients Âgés ◽

Acquired Hearing Loss ◽

Ear Effusion

Background: Otitis media with effusion is characterized by accumulation of fluid in the middle ear in absence of acute inflammation and it is the most common cause of acquired hearing loss in children, and may negatively affect language development failure of medical treatment of middle ear effusion frequently require myringotomy and tympanostomy tube insertion. Objectives: To determine tympanostomy tube complications of tube in children with chronic otitis media with effusion who were treated with Shah Grommet tube insertion. Methods: The Medical records of 162 ears of 87 children (52 male and 35 female) were reviewed respectively, the patients ages were between 3 to 16 years old (mean age =8.11 years), patient were followed for 6-66 months (mean 23.3) after tympanostomy tube insertion. Tube extrusion time was also reviewed in all patients, and the indication for surgery was chronic middle ear effusion. Results: Otorrhea accured in nine ears (5.6%), granulation tissue was seen in 2 ears (1.2%), myringosclerosis in (34.6%) persistent perfor-ation (5.6%), atrophy (23.5%) retraction (16.7%) and medial displacement 1.2% the average extrusion time was 8.5 month ( ± 4.6). Conclusions: complications of tympanostomy tube insertion are common and the most common are otorrhea myringosclerosis, atrophy but they are generally insignificant consequently in majority of these complications there is no need for management.

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Grommets – an update on common indications for tympanostomy tube placement

South African General Practitioner ◽

10.36303/sagp.2020.3.0019 ◽

2020 ◽

pp. 115-117

Author(s):

K Outhoff

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Acute Otitis Media ◽

Chronic Otitis Media ◽

Tube Placement ◽

Tympanostomy Tube ◽

Tube Insertion ◽

Tube Lumen ◽

Increased Risk

Children younger than 7 years are at increased risk of otitis media because of their immature immune systems and poorly functioning eustachian tubes that normally ventilate the middle ear space and equalise pressure with the external environment. More than 80% of children have at least one episode of acute otitis media (AOM) before the age of 3 years and 40% experience six or more recurrences by the time they are 7 years old. By the age of 3 years, approximately 7% of children undergo surgery for tympanostomy tube insertion for a range of otitis media issues, most commonly for chronic otitis media with effusion (OME), recurrent AOM, and acute otitis media that persists despite antibiotic therapy. However, tympanostomy tube insertion is associated with risks and remains a controversial practice especially in children with OME of less than three months’ duration and in children with recurrent AOM. Adverse effects associated with tympanostomy tube insertion include those associated with anaesthesia and its complications (laryngospasm, bronchospasm), as well as tube related sequelae such as recurrent (7%) or persistent (16–26%) otorrhoea, blockage of the tube lumen (7%), granulation tissue (4%), premature extrusion of the tube (4%), tympanostomy tube displacement into the middle ear (0.5%) and persistent perforation of the tympanic membrane (1–6%). This article offers guidance for family practitioners wishing to optimise health outcomes in children potentially requiring tympanostomy tube placement.

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Impact of Patient Socioeconomic Disparities on Time to Tympanostomy Tube Placement

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211015741 ◽

2021 ◽

pp. 000348942110157

Author(s):

Jennifer L. McCoy ◽

Ronak Dixit ◽

R. Jun Lin ◽

Michael A. Belsky ◽

Amber D. Shaffer ◽

...

Keyword(s):

Otitis Media ◽

Otitis Media With Effusion ◽

Private Insurance ◽

Chronic Otitis Media ◽

The United States ◽

Socioeconomic Disparities ◽

Tube Placement ◽

Median Income ◽

Public Insurance ◽

Tympanostomy Tubes

Objectives: Extensive literature exists documenting disparities in access to healthcare for patients with lower socioeconomic status (SES). The objective of this study was to examine access disparities and differences in surgical wait times in children with the most common pediatric otolaryngologic surgery, tympanostomy tubes (TT). Methods: A retrospective cohort study was performed at a tertiary children’s hospital. Children ages <18 years who received a first set of tympanostomy tubes during 2015 were studied. Patient demographics and markers of SES including zip code, health insurance type, and appointment no-shows were recorded. Clinical measures included risk factors, symptoms, and age at presentation and first TT. Results: A total of 969 patients were included. Average age at surgery was 2.11 years. Almost 90% were white and 67.5% had private insurance. Patients with public insurance, ≥1 no-show appointment, and who lived in zip codes with the median income below the United States median had a longer period from otologic consult and preoperative clinic to TT, but no differences were seen in race. Those with public insurance had their surgery at an older age than those with private insurance ( P < .001) and were more likely to have chronic otitis media with effusion as their indication for surgery (OR: 1.8, 95% CI: 1.2-2.5, P = .003). Conclusions: Lower SES is associated with chronic otitis media with effusion and a longer wait time from otologic consult and preoperative clinic to TT placement. By being transparent in socioeconomic disparities, we can begin to expose systemic problems and move forward with interventions. Level of Evidence: 4

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