Results after Treatment of Otitis Media with Effusion

1980 ◽  
Vol 89 (3_suppl) ◽  
pp. 308-311 ◽  
Author(s):  
G. Muenker
Keyword(s):  
Inner Ear ◽  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Bone Conduction ◽  
Tube Insertion ◽  
Tympanostomy Tubes ◽  
Ear Infections ◽  
Inner Ear Damage

Otitis media with effusion will be observed in every fifth child admitted for adenoid surgery; in children with cleft palates the incidence is 50%. With adenoidectomy alone, normal hearing can be restored in 50% and improved in further 25% of the patients. Over a 12-year period 1,683 patients with otitis media with effusion were treated with adenoidectomy and with insertion of tympanostomy tubes in those cases where adenoidectomy proved to be ineffective. Since the tubes only substitute tubal function, recurrences have to be expected in more than 30% after spontaneous extrusion of the tubes. Of all recurrences, 93% occur within two years after tube insertion. With thorough follow-up and repeated insertion of tubes, deterioration of the middle ear can be avoided and hearing kept normal. Impaired bone conduction does not reflect inner ear damage, but will improve with ventilation of the middle ear. Infections occur in 15% (5% postoperatively, 10% later); persistent perforations in 2.5% and cholesteatoma in 0.9%.

Tympanic Membrane Perforations and Tympanostomy Tubes

1994 ◽  
Vol 103 (5_suppl) ◽  
pp. 27-30 ◽  
Author(s):  
Sam Levine ◽  
Kathleen Daly ◽  
G. Scott Giebink
Keyword(s):  
Tympanic Membrane ◽  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Chronic Otitis Media ◽  
Tympanic Membrane Perforations ◽  
Tympanostomy Tubes ◽  
Preoperative Factor ◽  
Middle Ear Disease

Tympanoplasty and tympanostomy tubes were developed at the same time and have dramatically changed the treatment of chronic middle ear disease. One hundred forty-nine children who had tubes inserted between ages 6 months and 8 years for chronic otitis media with effusion have been prospectively followed up for an average of 4 years. Fourteen percent developed tympanic membrane perforations. No preoperative factor completely predicted the development of perforation. a majority of the perforations closed spontaneously. Three ears had noncontiguous observations of perforations during follow-up. The implications of these findings are discussed with respect to tympanoplasty.

Effects of Platelet Activating Factor on the Tubotympanic Mucosa and Inner Ear in the Guinea Pig

1998 ◽  
Vol 107 (10) ◽  
pp. 876-884 ◽  
Author(s):  
Yoshiharu Ohno ◽  
Yoshihiro Ohashi ◽  
Hideki Okamoto ◽  
Yoshikazu Sugiura ◽  
Yoshiaki Nakai
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Inner Ear ◽  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Platelet Activating Factor ◽  
Sensorineural Hearing ◽  
Ciliary Activity ◽  
Middle Ear Mucosa

The effect of platelet activating factor (PAF) was studied to elucidate its role in the pathogenesis of otitis media and sensorineural hearing loss. The PAF alone did not induce a reduction of ciliary activity of the cultured middle ear mucosa. However, a dose-dependent decrease in ciliary activity was observed in the presence of the medium containing both PAF and macrophages. Intravenous injection of PAF did not induce dysfunction of the mucociliary system or morphologic changes of epithelium in the tubotympanum, but cytoplasmic vacuolization and ballooning were observed in the inner ear within 1 hour after injection of PAF. In contrast, intratympanic injection of PAF induced mucociliary dysfunction and some pathologic changes in the tubotympanum. Intratympanic inoculation of PAF induced no pathologic findings in the inner ear. These results suggest that PAF is at least partially involved in the pathogenesis of certain middle ear diseases such as otitis media with effusion. Additionally, PAF might be involved in the pathogenesis of some types of unexplained sensorineural hearing loss.

Chronic Secretory Otitis Media: Effects of Surgical Management

1989 ◽  
Vol 98 (1_suppl2) ◽  
pp. 2-32 ◽  
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.

Otitis Media with Effusion: Results of Treatment with a Short Course of Oral Prednisone or Intranasal Beclomethasone Aerosol

1981 ◽  
Vol 89 (3) ◽  
pp. 386-391 ◽  
Author(s):  
Richard H. Schwartz
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Oral Prednisone ◽  
Pilot Project ◽  
Results Of Treatment ◽  
Short Course ◽  
Novel Method ◽  
Ear Effusion

A short course of prednisone suspension given in a decreasing dosage schedule for up to ten days was often effective (68%) in resolving mucoid otitis media with effusion (OME, middle ear effusion). No significant side effects were noted. Concommitant administration of sulfisoxazole suspension may have reduced the likelihood of activation of a quiescent infection of the middle ear. During an eight-month mean follow-up period, reaccumulation of the effusion was detected in 21% of the successfully treated children. Preliminary results of an unrelated, pilot project using intranasal beclomethasone dipropionate aerosol suggests that this novel method also may be efficacious in the treatment of OME.

scholarly journals The Middle Ear in Cleft Palate Children Pre and Post Palatal Closure

1988 ◽  
Vol 81 (12) ◽  
pp. 710-713 ◽  
Author(s):  
R S Dhillon
Keyword(s):  
Cleft Palate ◽  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Prospective Trial ◽  
Ventilation Tube ◽  
Long Term Ventilation ◽  
Palatal Surgery

A multicentre prospective trial was commenced in July 1984 to establish the incidence of otitis media with effusion (OME) in children born with a cleft of the palate. Additionally, the data recorded would allow an assessment of the effect of palatal closure on middle ear function. Prior to palatal closure, 97% of ears in a group of 50 patients had otitis media with effusion (OME). The insertion of a long-term ventilation tube provided a means of aeration of one ear with the non-ventilated ear acting as a control. Eighty percent of control ears had persistent OME during a 24-month follow-up period post palatal repair. It would seem that OME is universally present in children with a cleft palate prior to 4 months of age and this incidence is only marginally diminished by palatal surgery. The liaison between plastic surgical and ENT units should be even closer than before in order to manage these patients satisfactorily.

Adenoidectomy and Otitis Media

1992 ◽  
Vol 101 (1_suppl) ◽  
pp. 24-32 ◽  
Author(s):  
George A. Gates ◽  
Harlan R. Muntz ◽  
Brendan Gaylis
Keyword(s):  
Otitis Media ◽  
Pathogenic Bacteria ◽  
Otitis Media With Effusion ◽  
Chronic Otitis Media ◽  
Tube Insertion ◽  
Secretory Otitis Media ◽  
Randomized Controlled ◽  
Source Of Infection ◽  
Randomized Controlled Studies ◽  
Tympanostomy Tubes

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.

Subannular Tubes in Children With Cleft Palate

2021 ◽  
pp. 105566562199017
Author(s):  
Sónia Pires Martins ◽  
Pedro Lopes Alexandre ◽  
Margarida Santos ◽  
Carla Pinto Moura
Keyword(s):  
Cleft Palate ◽  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Tube Obstruction ◽  
Tube Extrusion ◽  
Tertiary Center ◽  
Retraction Pockets ◽  
Middle Ear Disease

Objective: To investigate subannular tube (SAT) placement as an alternative treatment of chronic middle ear disease in children with cleft palate. Design: Retrospective cohort study. Participants: All children with cleft palate with intractable otitis media with effusion and/or with tympanic membrane retraction, operated for insertion of 1 or more sets of transtympanic tubes followed by SAT in a tertiary center. Main Outcome Measures: Audiological outcomes, average duration of tubes, and postoperative complications were analyzed. Results: This study included 21 children with cleft palate, aged 3 to 14 years. A total of 38 ears was evaluated. The median time of follow-up was 42 months. During follow-up, 69.2% of the patients had no complications. Observed complications were otorrhea (13.5%) and tube obstruction (7.7%). In 7.9% of the cases, otitis media with effusion relapsed after tube extrusion. By the end of the study, 76.3% of the tubes remained in situ and 68.4% of the tympanic membranes had the SAT in place and had no significant alterations. The mean duration of SATs was 16 months, which was significantly superior to transtympanic tube duration. A significant sustained improvement in the hearing of children with SATs was observed. Conclusion: Subannular tube insertion results in hearing improvement to normal range and tympanic retraction pockets reversion in children with cleft palate with persistent otitis media with effusion and tympanic retraction/atelectasis. This surgery appears to be safe and provides long-term efficient middle ear aeration. Strict postoperative follow-up is crucial for the success of the treatment.

scholarly journals Importance of early ventilation tubes insertion in chronic otitis media with effusion in children with congenital cleft palate

2018 ◽  
Vol 75 (3) ◽  
pp. 253-259
Author(s):  
Vladan Subarevic ◽  
Nenad Arsovic ◽  
Radoje Simic ◽  
Katarina Stankovic
Keyword(s):  
Cleft Palate ◽  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Speech Development ◽  
Middle Ear Effusion ◽  
Ventilation Tubes ◽  
Congenital Cleft ◽  
Ear Effusion

Background/Aim. Otitis media with effusion (OME) is almost universal in children with cleft palate with an incidence of more than 90%, but the approach to managing this problem varies significantly among authors. The Eustachian tube dysfunction is the main factor that leads to the presence of the middle ear effusion. This is especially prominent in children with congenital cleft palate and explains the prolonged course of this process. The objective of this study was to determine the effectiveness of early ventilation tubes insertion in children with cleft palate at the time of palatoplasty by monitoring the course and duration of the disease as well as development of complications. Methods. In the prospective study with predefined regular follow-up intervals and parameters, the two groups of children were observed. The group one (E) included 45 children with congenital cleft palate who underwent the early insertion of ventilation tubes during palatoplasty, and the group two (C) had the same number of children with cleft palate who were treated conservatively on an as-needed basis. Assessment parameters were findings of otomicroscopy, tympanometry, play and pure tone audiometry. Each child was followed-up for 5 full years at total of nine follow-up examinations. Results. Result analysis showed that there were no statistically important differences between the two study groups in terms of the course and duration of the presence of the middle ear effusion, or in terms of complications and speech development. Conclusion. Based on the results obtained, we can conclude that there is no significant benefit in early ventilation tubes insertion in children with cleft palate, therefore our recommendation is watchful waiting and a conservative treatment on an as-needed basis, with the ventilation tubes insertion when a surgeon, based on his or her experience and individual findings considers it necessary.

Mechanism of Hearing Loss in Irradiated Ears: A Long-Term Longitudinal Study

2001 ◽  
Vol 110 (10) ◽  
pp. 904-906 ◽  
Author(s):  
Yi-Ho Young ◽  
Ying-Chih Lu
Keyword(s):  
Hearing Loss ◽  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Bone Conduction ◽  
Chronic Otitis Media ◽  
Pure Tone Audiometry ◽  
Tube Function ◽  
The Mean ◽  
Air Conduction

A 10-year longitudinal follow-up study of hearing was conducted in patients with nasopharyngeal carcinoma (NPC) in order to elucidate the mechanism of hearing loss in irradiated ears. Ten NPC patients were subjected to a battery of audiological tests before irradiation and 6 months, 5 years, and 10 years after irradiation. The tests included pure tone audiometry, tympanometry, eustachian tube function testing, and myringotomy to confirm middle ear effusion. The prevalences of otitis media with effusion (OME) were 25%, 25%, 40%, and 25% at the 4 testing periods described above, respectively. The prevalences of chronic otitis media were 0%, 0%, 15%, and 25%, respectively. In myringotomized ears (n = 17), the mean hearing levels for both air conduction and bone conduction were preserved from the preirradiation period to 10 years after irradiation. In contrast, in grommeted ears (n = 3), the mean hearing levels for both air conduction and bone conduction deteriorated progressively from the preirradiation period to 10 years after irradiation. We conclude that hearing can be preserved in NPC patients 10 years after irradiation if middle ear inflammation is well controlled. We do not recommend grommet insertion in irradiated NPC patients with OME, as it may result in persistent otorrhea and hearing deterioration.

scholarly journals Tympanostomy Tube Controversies and Issues: State-of-the-Art Review

2020 ◽  
Vol 99 (1_suppl) ◽  
pp. 15S-21S
Author(s):  
Richard M. Rosenfeld
Keyword(s):  
Otitis Media ◽  
Expert Opinion ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Tube Insertion ◽  
Published Evidence ◽  
Recommendations For Action ◽  
Tympanostomy Tubes ◽  
High Level

Objective: To review current pragmatic issues and controversies related to tympanostomy tubes in children, in the context of current best research evidence plus expert opinion to provide nuance, address uncertainties, and fill evidence gaps. Methods: Each issue or controversy is followed by the relevant current best evidence, expert insight and opinion, and recommendations for action. The role of expert opinion and experience in forming conclusions is inversely related to the quality, consistency, and adequacy of published evidence. Conclusions are combined with opportunities for shared decision-making with caregivers to recommend pragmatic actions for clinicians in everyday settings. Results: The issues and controversies discussed include (1) appropriate tube indications, (2) rationale for not recommending tubes for recurrent acute otitis media without persistent middle ear effusion, (3) role of tubes in at-risk children with otitis media with effusion, (4) role of new, automated tube insertion devices, (5) appropriateness and feasibility of in-office tube insertion in awake children, (6) managing methicillin-resistant Staphylococcus aureus acute tube otorrhea, and (7) managing recurrent or persistent tube otorrhea. Conclusions: Despite a substantial, and constantly growing, volume of high-level evidence on managing children with tympanostomy tubes, there will always be gaps, uncertainties, and controversies that benefit from clinician experience and expert opinion. In that regard, the issues discussed in this review article will hopefully aid clinicians in everyday, pragmatic management decisions.

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