Should we aspirate middle-ear effusions prior to insertion of ventilation tubes?

Background: Routine aspiration of middle-ear effusions prior to ventilation tube (grommet) insertion is practised by many surgeons. It has been suggested that removing the fluid from the middle ear improves immediate post-operative hearing levels and reduces the chance of the ventilation tube becoming obstructed. The potential adverse effects of applying suction to the middle ear include acoustic trauma and an increased risk of tympanosclerosis and otorrhoea. We undertook a review of the literature in order to determine the benefits or side effects associated with middle-ear aspiration prior to ventilation tube insertion.Objectives: To compare clinical outcomes associated with aspirating versus not aspirating the middle ear prior to ventilation tube insertion.Methods: The Cochrane ENT group trials register, DARE, the Cochrane central register of controlled trials (CENTRAL), MEDLINE (1960–2005) and EMBASE (1960–2005) were searched using relevant terms. Reference lists of selected studies were scanned for additional research material.Results: Seven studies were identified, of which three fitted the inclusion criteria of our review. Current evidence suggests that aspiration of middle-ear effusions prior to insertion of ventilation tubes is not associated with any improvement in clinical outcome, in terms of post-operative hearing levels, otorrhoea or rates of blockage of ventilation tubes. Significantly increased rates of tympanosclerosis were observed in one study and the development of acoustic trauma was observed; however, no significant association was confirmed. Although more research is needed, there is no evidence that aspiration of middle-ear effusion prior to grommet insertion confers any advantage.

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Early Placement of Ventilation Tubes in Infants with Cleft Lip and Palate: A Systematic Review

Otolaryngology ◽

10.1177/0194599817742840 ◽

2017 ◽

Vol 158 (3) ◽

pp. 459-464 ◽

Cited By ~ 6

Author(s):

Mark Felton ◽

Jong Wook Lee ◽

Darius D. Balumuka ◽

Jugpal S. Arneja ◽

Neil K. Chadha

Keyword(s):

Middle Ear ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Data Sources ◽

Tube Placement ◽

Cochrane Central Register ◽

Ventilation Tube ◽

Tube Insertion ◽

Ventilation Tubes ◽

Palate Repair

Objective Studies have shown that the majority of cleft lip and palate (CLP) children have middle ear fluid present at the time of lip repair (3-4 months). Despite hearing loss, the majority of children do not undergo ventilation tube treatment if required until the time of palate repair (9-12 months). We aimed to examine the effectiveness and potential complications of early ventilation tube placement prior to palatoplasty in infants with cleft lip and palate. Data Sources Medline (1946-2015), Embase (1980-2015), and EBM Reviews (Cochrane Central Register of Controlled). Review Methods Data sources were searched for publications that described the results of early ventilation tube placement in children with CLP prior to cleft palate repair. Two independent reviewers appraised the selected studies. Results Of 226 studies identified, 6 studies met the inclusion criteria. Early ventilation tube insertion in CLP gave similar speech and audiology outcomes to non-CLP children undergoing ventilation tube insertion and better outcomes than those children with CLP having later ventilation tube insertion at or after the time of palate closure. The main reported side effect was otorrhea, being higher for children with CLP having early ventilation tube insertion (67% vs 33%), with a reduction in otorrhea with increasing age. Larger studies with longer-term outcome reporting are required to fully address the study objectives. Conclusion Published data are limited but appear to support early insertion of ventilation tubes in children with CLP to restore middle ear function and maximize audiologic and speech outcomes.

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Blue Ear Drum and its Management

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894760850s256 ◽

1976 ◽

Vol 85 (2_suppl) ◽

pp. 293-295 ◽

Cited By ~ 2

Author(s):

Michael M. Paparella

Keyword(s):

Middle Ear ◽

Proper Treatment ◽

Blood Products ◽

Ventilation Tube ◽

Radical Mastoidectomy ◽

Long Period ◽

Modified Radical Mastoidectomy ◽

Ventilation Tubes ◽

Serous Otitis Media ◽

Mastoid Surgery

The “blue ear drum” generally refers to a condition in which blood or blood products are found in the middle ear. After all possible causes for hemotympanum, including blood dyscrasias and trauma are searched for and ruled out, the patient may have chronic serous otitis media accompanied by bloody effusion. Treatment for all of these patients is conservative, consisting of medical therapy and, if need be, myringotomy and insertion of ventilation tubes. In spite of proper treatment, rarely the condition may progress, over a long period of time, to a state of intractability. Characteristic findings are a hypocellular mastoid, hyperplastic and metaplastic mucoperiosteal lining, including the presence of glands and cysts and Cholesterin granuloma. The recommended procedure is a modified radical mastoidectomy, placement of silicone rubber sheeting in the middle ear and insertion of a ventilation tube. It is to be emphasized that mastoid surgery is rarely indicated for these patients and only after all else has failed.

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Association between thyroid disorders and COVID-19: a protocol for a systematic review and meta-analysis

Thyroid Research ◽

10.1186/s13044-021-00113-1 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Soraya Doustmohammadian ◽

Azam Doustmohammadian ◽

Marjan Momeni

Keyword(s):

Assessment Tool ◽

Heart Diseases ◽

Data Extraction ◽

Meta Analysis ◽

Current Evidence ◽

Thyroid Disorders ◽

Cochrane Central Register ◽

Cochrane Reviews ◽

Increased Risk ◽

Review Team

Abstract Background The novel coronavirus (COVID-19) epidemic initially appeared in Wuhan, Hubei Province, China, on 31 December 2019 and was spread rapidly worldwide. Most underlying diseases reported with COVID-19 patients are diabetes, hypertension, coronary heart diseases, and cerebrovascular disease. We do not know whether individuals with thyroid disease are at increased risk of COVID-19 infection. Methods Two experienced researchers will conduct an electronic search of the databases including PubMed/MEDLINE, the Cochrane Reviews, and the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, and ProQuest, for articles published since October 2019. Clinical trials and observational studies will be included. Studies will be screened after de-duplication. A standardized data extraction form will be developed through discussions with the review team and will be revised after piloting. An appropriate risk of bias assessment tool will be used to assess the quality of studies. Two independent reviewers will assess the eligibility, extraction of detailed information, and quality assessment of studies. The results will be pooled for meta-analysis, subgroup analysis and/or descriptive analysis based on the included data conditions. Conclusion Results of this study will provide current evidence on the association of COVID-19 diseases with any thyroid disorders such as hypothyroidism, thyrotoxicosis, and thyroid cancer with or without radioiodine therapy. Findings will be disseminated in peer-reviewed publications and conference presentations. Trial registration PROSPERO registration number: CRD42020184289. https://www.crd.york.ac.uk/PROSPERO/#recordDetails

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Clinical Analysis of Outpatient Anesthesia in Children with Middle Ear Ventilation Tube Insertion

Korean Journal of Anesthesiology ◽

10.4097/kjae.2005.49.2.183 ◽

2005 ◽

Vol 49 (2) ◽

pp. 183 ◽

Cited By ~ 1

Author(s):

Yoonki Lee ◽

Hyunju Kwon

Keyword(s):

Middle Ear ◽

Clinical Analysis ◽

Ventilation Tube ◽

Tube Insertion ◽

Middle Ear Ventilation

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Cemented Titanium Ventilation Tube in the Chinchilla

Otolaryngology ◽

10.1016/j.otohns.2008.05.518 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P99-P99

Author(s):

Jeffery J Kuhn ◽

Scott R Anderson ◽

Barry Strasnick

Keyword(s):

Bone Cement ◽

Middle Ear ◽

Medial Wall ◽

Ventilation Tube ◽

Novel Technique ◽

Middle Ear Ventilation ◽

Ventilation Tubes ◽

Titanium Tube ◽

Long Term Ventilation

Problem The use of long-term ventilation tubes in patients with chronic eustachian tube dysfunction is an acceptable form of initial surgical treatment. Despite improvements in composition and design, early extrusion, occlusion, and need for repeated procedures continue to be frequent problems encountered in the course of treatment. The purpose of this study was to develop a novel technique for establishing permanent middle ear ventilation. The study was conducted following the refinement of surgical techniques and long-term follow-up in a pilot group of animals. Methods Heat cautery myringotomy was used to expose the middle ear space in both ears of 15 chinchillas. A titanium ventilation tube was fixed to the medial wall of the hypotympanum in each ear using OtoMimix hydroxyapatite bone cement. At four months, both ears in 12 animals were re-explored and the integrity of the cemented tube was assessed clinically. One animal was euthanized and the temporal bones obtained for histopathologic analysis. Results A stable fixation of the titanium tube to the medial wall of the hypotympanum was demonstrated in 23 of 24 ears at four months re-exploration. The titanium tube-bone cement fixture was covered with healthy vascularized mucosa in all ears. Two ears showed mild mucosal inflammation adjacent to the fixed tube. The histologic findings will be reviewed. Conclusion The use of hydroxyapatite bone cement to permanently secure a titanium tube to the middle ear wall appears to have some promise as a technique for establishing long-term ventilation of the middle ear space. A prototype titanium tube is currently being developed for this purpose. Significance By incorporating the proven technologies of titanium implants and hydroxyapatite bone cement, this study provides a novel technique for establishing a permanent means of middle ear ventilation. Support The ventilation tubes (Gyrus ENT LLC) and bone cement (Walter Lorenz Surgical, Inc.) were supplied by their respective manufacturers.

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Febuxostat use and risks of CVD events, death from cardiac-cause and all-cause mortality: metaanalysis of randomized controlled trials

The Journal of Rheumatology ◽

10.3899/jrheum.200307 ◽

2020 ◽

pp. jrheum.200307

Author(s):

Hao Deng ◽

Bao Long Zhang ◽

Jin Dong Tong ◽

Xiu Hong Yang ◽

Hui Min Jin

Keyword(s):

Web Of Science ◽

Meta Analysis ◽

Relevant Literature ◽

Controlled Trials ◽

Cochrane Central Register ◽

Inclusion Criteria ◽

Randomized Controlled ◽

Central Register ◽

Increased Risk ◽

All Cause Mortality

Objective To assess whether febuxostat use increases the risk of developing cardiovascular events, death from cardiac-cause and all-cause mortalities. Methods The relevant literature was searched in several databases including the MEDLINE (PubMed, 1 Jan. 1966–29 Feb. 2020), Web of science, EMBASE (1 Jan. 1974–29 Feb. 2020), ClinicalTrials.gov and Cochrane Central Register for Controlled Trials. Manual searches for references cited in the original studies and relevant review articles were also performed. All studies included in this metanalysis were published in English. Results In the end, 20 studies that met our inclusion criteria were included in this meta-analysis. Use of febuxostat was found not to be associated with an increased risk of all-cause mortality (RR = 0.87, 95% CI 0.57–1.32, P =0.507). Also, there was no association between febuxostat use and mortalities arising from cardiovascular diseases (CVD) (RR = 0.84, 95% CI 0.49–1.45, P=0.528). The RR also revealed that febuxostat use was not associated with CVD events (RR = 0.98, 95% CI 0.83–1.16, P =0.827). Furthermore, the likelihood of occurrence of CVD events was found not to be dependent on febuxostat dose (RR = 1.04, 95% CI 0.84–1.30, P =0.723). Conclusion Febuxostat use is not associated with increased risks of all-cause mortality, death from CVD or CVD events. Accordingly, it is a safe drug for the treatment of gout. Systematic review registration: PROSPERO CRD42019131872

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External ear canal cholesteatoma after ventilation tube insertion and mastoidectomy

Vojnosanitetski pregled ◽

10.2298/vsp1204363d ◽

2012 ◽

Vol 69 (4) ◽

pp. 363-366 ◽

Cited By ~ 1

Author(s):

Dragoslava Djeric ◽

Milan Jovanovic ◽

Ivan Baljosevic ◽

Srbislav Blazic ◽

Milanko Milojevic

Keyword(s):

Tympanic Membrane ◽

Middle Ear ◽

Membrane Surface ◽

Tube Placement ◽

External Ear ◽

Ventilation Tube ◽

Ear Canal ◽

Tube Insertion ◽

Tissue Mass ◽

External Ear Canal

Introduction. Etiopathogenetically, there are two types of chollesteatomas: congenital, and acquired. Numerous theories in the literature try to explain the nature of the disease, however, the question about cholesteatomas remain still unanswered. The aim of the study was to present a case of external ear canal cholesteatoma (EEC) developed following microsurgery (ventilation tube insertion and mastoidectomy), as well as to point ant possible mechanisms if its development. Case report. A 16-yearold boy presented a 4-month sense of fullness in the ear and otalgia on the left side. A year before, mastoidectomy and posterior atticotomy were performed with ventilation tube placement due to acute purulent mastoiditis. Diagnosis was based on otoscopy examination, audiology and computed tomography (CT) findings. CT showed an obliterative soft-tissue mass completely filled the external ear canal with associated erosion of subjacent the bone. There were squamous epithelial links between the canal cholesteatoma and lateral tympanic membrane surface. They originated from the margins of tympanic membrane incision made for a ventilation tube (VT) insertion. The position of VT was good as well as the aeration of the middle ear cavity. The tympanic membrane was intact and of normal appearance without middle ear extension or mastoid involvement of cholesteatoma. Cholesteatoma and ventilation tube were both removed. The patient recovered without complications and shortly audiology revealed hearing improving. Follow-up 2 years later, however, showed no signs of the disease. Conclusion. There could be more than one potential delicate mechanism of developing EEC in the ear with VT insertion and mastoidectomy. It is necessary to perform routine otologic surveillance in all patients with tubes. Affected ear CT scan is very helpful in showing the extent of cholesteatoma and bony defects, which could not be assessed by otoscopic examination alone.

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Increasing rate of middle ear ventilation tube insertion in children in denmark

International Journal of Pediatric Otorhinolaryngology ◽

10.1016/j.ijporl.2014.06.034 ◽

2014 ◽

Vol 78 (9) ◽

pp. 1541-1544 ◽

Cited By ~ 14

Author(s):

Bjarki Ditlev Djurhuus ◽

Axel Skytthe ◽

Kaare Christensen ◽

Christian Emil Faber

Keyword(s):

Middle Ear ◽

Ventilation Tube ◽

Tube Insertion ◽

Middle Ear Ventilation

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Postoperative Controls of ventilation tubes in children - by general practitioner or otolaryngologist? Study protocol for a multicenter randomized non-inferiority study (The ConVenTu study)

10.21203/rs.2.23375/v3 ◽

2020 ◽

Author(s):

Bjarne Austad ◽

Ann Helen Nilsen ◽

Anne-Sofie Helvik ◽

Grethe Albrektsen ◽

Ståle Nordgård ◽

...

Keyword(s):

Quality Of Life ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Evidence Based ◽

Health Related Quality ◽

Ventilation Tube ◽

Related Quality ◽

Ventilation Tubes ◽

Health Related

Abstract Background: Otitis media with effusion is the major cause of acquired hearing problems in children. Some of the affected children need surgery with ventilation tubes in the tympanic membrane to reduce ear complaints and to improve hearing, middle ear function and health-related quality of life. This is one of the most common ambulatory surgeries performed on children. Postoperative controls are needed to assess that the tubes are functional, evaluate whether hearing loss has been improved, and to handle potential complications. The follow-up may continue for years and are usually done by otolaryngologists. Nevertheless: there exist no evidence-based guidelines concerning the level of expertise needed for postoperative controls of the ventilation tubes. The aim of this protocol is to describe the ConVenTu study that evaluates whether postoperative controls performed by general practitioners (GPs), represent a safe and sufficient alternative to controls performed by otolaryngologists. Methods/design: Multicenter randomized non-inferiority study conducted in clinical settings in seven hospitals located in Norway. Discharged children with ventilation tubes, aged 3-10 years are allocated randomly to receive postoperative controls by either an otolaryngologist at the hospital where they had ventilation tube surgery or their regular GP. Study participants are enrolled consecutively until 200 patients are included in each group. Two years after surgery we will compare pure tone average of hearing thresholds (primary endpoint) and middle ear function, complication rate, health-related quality of life and the parents’ evaluations of the postoperative care (secondary endpoints). Discussion: This protocol describes the first randomized non-inferiority study of GPs performing postoperative controls after surgery with ventilation tubes. Results from this study may be utilized for deriving evidence-based clinical practice guidelines of the level of postoperative controls after ventilation tube surgery which is safe and sufficient.

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