SHORT-TERM EFFICACY OF TYMPANOSTOMY TUBES FOR SECRETORY OTITIS MEDIA IN CHILDREN WITH DOWN SYNDROME

Otorrhea is the most frequent complication of the use of tympanostomy tubes. When it occurs after the immediate postoperative period, otorrhea is probably the result of external contamination of the middle ear or acute otitis media. We analyzed data from 627 operations upon 1248 ears of 491 children with chronic secretory otitis media and found that delayed onset (longer than 7 weeks) postoperative otorrhea occurred after 26.4 percent of the 382 operations in which tympanostomy tubes were used. The average number of episodes of otorrhea per case was 1.46 and ranged from 1 to 9. The rate of otorrhea occurrence in patients with tubes in place was significantly higher in the summer months. Otorrhea also occurred after 9.0 percent of 245 myringotomy procedures. The average number of episodes was 1.32 and ranged from 1 to 3. Treatment of postoperative otorrhea increases the health care costs of surgical treatment of chronic otitis media with effusion; this problem should be included in the calculation of cost-effectiveness.

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Features of lesion of ENT-organs in children with Down syndrome

Modern pediatrics. Ukraine ◽

10.15574/sp.2020.109.15 ◽

2020 ◽

pp. 15-18

Author(s):

A.L. Kosakovskyi ◽

◽

Iu. Gavrylenko ◽

M. Kyianytsia ◽

◽

...

Keyword(s):

Down Syndrome ◽

Otitis Media ◽

Primary Care Physicians ◽

Significant Proportion ◽

Acute Otitis Media ◽

Educational Work ◽

Children With Down Syndrome ◽

Obstructive Sleep ◽

Hearing Test ◽

Families With Children

Objective: сlinical relevance and prevalence of ENT diseases in children with Down syndrome (DS) of Ukrainian, according to a survey of their parents. Analyze educational work among primary care physicians. Materials and methods. During 2019, 137 respondents, who were parents of children with Down syndrome, were surveyed. Аge varied from 3 months to 18 years. Results. Scheduled medical examinations in ENT doctors have the ability to conduct 81% of families with children with DS. 72.3% of the interviewed had their hearing assessed, of whom 19% had their hearing checked annually. 27.7% of children with DS do not have a hearing test. A significant proportion (81%) of parents of children with DS did not offer to assess the child's hearing. Acute otitis media is more commonly recorded at the age of 1 to 5 years. Surgical treatment for otitis media was performed in 7.2% of patients (tympano puncture/tympanocentesisin 5.1%; performed more than 2 times in 0.7%; middle ear bypass grafting in 1.5%). Acute bacterial rhinosinusitis was noted in 40.9% of children with DS, of which 82.1% had more than 3 episodes of acute rhinosinusitis during their lifetime. Allergies were reported in 34.3%. Obstructive sleep apnea is noted by 26.3%. 70.8% of parents observe their baby's shortness of breath, snoring. As for surgery: adenotomy was performed in 20.5%, of which 1.5% of children performed more than 1 time. Adenotomy is planned in 30% of the respondents. Tonsillectomy was performed in 1.5%, with 0.7% planned for the near future. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the parents and patients was obtained for conducting the studies. No conflict of interest was declared by the authors. Keywords: Down syndrome, ENT pathology, ENT organs, children, adolescents.

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Chronic Secretory Otitis Media: Effects of Surgical Management

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894890981s202 ◽

1989 ◽

Vol 98 (1_suppl2) ◽

pp. 2-32 ◽

Cited By ~ 42

Author(s):

George A. Gates ◽

J. C. Cooper ◽

Christine A. Avery ◽

Thomas J. Prihoda

Keyword(s):

Hearing Loss ◽

Otitis Media ◽

Surgical Management ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Chronic Otitis Media ◽

Secretory Otitis Media ◽

Tympanostomy Tubes ◽

The Mean ◽

First Recurrence

To study the effectiveness of adenoidectomy and tympanostomy tubes in the treatment of chronic otitis media with effusion, we randomly assigned 578 4- to 8-year-old children to receive one of the following: Bilateral myringotomy and no additional treatment (group 1), tympanostomy tubes (group 2), adenoidectomy and myringotomy (group 3), or adenoidectomy and tympanostomy tubes (group 4). The 491 who accepted surgical treatment were evaluated at 6-week intervals for up to 2 years. Treatment effect was assessed by four main outcomes: Time with effusion, time with hearing loss, time to first recurrence of effusion, and number of surgical re-treatments. For the groups (in order), the mean percent of time with any effusion in either ear was 49, 35, 30, 26 (p < .0001); the mean percent of time with hearing thresholds 20 dB or greater was 19, 10, 8, and 7 (p < .0001) in the better ear; and 38, 30, 22 and 22 in the worse ear (p < .0001); the median number of days to first recurrence was 54, 222, 92, and 240 (p < .0001); and the number of surgical re-treatments was 66, 36, 17, and 17 (p < .0001). The most notable adverse sequela, purulent otorrhea, occurred in 22%, 29%, 11%, and 24% of the patients assigned to groups 1 through 4, respectively (p < .001). In severely affected children who have chronic otitis media with effusion resistant to medical therapy, adenoidectomy is an effective treatment. Adenoidectomy plus bilateral myringotomy lowered posttreatment morbidity more than tympanostomy tubes alone and to the same degree as did adenoidectomy and tympanostomy tubes. Adenoidectomy appears to modify the underlying pathophysiology of chronic otitis media with effusion. This effect is independent of the preoperative size of the adenoid. Tympanostomy tube drainage and ventilation of the middle ear provide adequate palliation so long as the tubes remain in place and functioning. We recommend that adenoidectomy be considered in the initial surgical management of 4- to 8-year-old children with hearing loss due to chronic secretory otitis media that is refractory to medical management and, further, that the size of the adenoid not be used as a criterion for adenoidectomy. Concomitant bilateral myringotomy with suction aspiration of the middle ear contents also should be done, with or without placement of tympanostomy tubes at the discretion of the surgeon.

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