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.

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.

Delayed Onset Post-Tympanotomy Otorrhea

1988 ◽  
Vol 98 (2) ◽  
pp. 111-115 ◽  
Author(s):  
George A. Gates ◽  
Christine Avery ◽  
Thomas J. Prihoda ◽  
G. Richard Holt
Keyword(s):  
Health Care ◽  
Surgical Treatment ◽  
Otitis Media ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Chronic Otitis Media ◽  
Secretory Otitis Media ◽  
Delayed Onset ◽  
Tympanostomy Tubes ◽  
Care Costs

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.

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.

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.

Long-term middle-ear ventilation with subannular tubes

2010 ◽  
Vol 124 (9) ◽  
pp. 945-949 ◽  
Author(s):  
A Daudia ◽  
S Yelavich ◽  
P J D Dawes
Keyword(s):  
Tympanic Membrane ◽  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Case Series ◽  
Chronic Otitis Media ◽  
Tympanic Membrane Perforation ◽  
Retrospective Case ◽  
The Mean

AbstractObjective:Long-term tympanostomy tubes are associated with a significant rate of complications, particularly persistent perforation. We describe the outcomes of 57 subannular ventilation tube insertions in 45 consecutive patients.Design:Retrospective case series.Subjects:We studied 45 consecutive patients with chronic otitis media with effusion and hearing loss (n = 54 cases), associated with adhesive otitis media (n = 7), tympanic membrane retraction (n = 17) and tympanic membrane perforation (n = 3). The mean follow up was 48 months (range, nine to 95 months).Results:The mean duration of ventilation for tubes still in situ was 22 months (range, one to 76 months; n = 29), and for tubes which extruded or were removed 23 months (range, one to 85 months; n = 28). The mean improvement in air–bone gap was 14 dB (range, −14 to 35 dB). Complications included blockage (16 per cent), perforation after extrusion (9 per cent), granulation (5 per cent) and infection (4 per cent).Conclusion:Subannular ventilation tubes provide an effective option for management of intractable middle-ear effusion and eustachian tube dysfunction.

scholarly journals Primary Middle Ear Meningioma with Intact Tympanic Membrane: A Case Report and Literature Review

2021 ◽  
pp. 014556132110581
Author(s):  
Yuan-Jun Liu ◽  
Lin Han ◽  
Jie Cao ◽  
Hong-Wei Zheng ◽  
Li-Sheng Yu
Keyword(s):  
Tympanic Membrane ◽  
Otitis Media ◽  
Middle Ear ◽  
Clinical Symptoms ◽  
Otitis Media With Effusion ◽  
Relevant Literature ◽  
Chronic Otitis Media ◽  
Secretory Otitis Media ◽  
Ectopic Meningioma ◽  
Intact Tympanic Membrane

Primary ectopic meningioma of the middle ear is relatively rare in clinical practice. It is often difficult to distinguish it from chronic otitis media or otitis media with effusion due to its similar and atypical clinical symptoms. We report a case of epithelial tympanic ectopic meningioma with the main complaints of otalgia, aural fullness, and hearing loss. It was accidentally discovered during tympanotomy due to the symptoms of recurring refractory secretory otitis media. This article briefly reviews the relevant literature in recent years, summarizes the characteristics of primary ectopic tympanic meningioma with intact tympanic membrane, and emphasizes the diagnosis and treatment strategy of the middle ear mass.

Naproxen in otitis media with effusion

1986 ◽  
Vol 100 (3) ◽  
pp. 263-266 ◽  
Author(s):  
S. Abramovich ◽  
J. O'Grady ◽  
A. Fuller ◽  
M. MacKinnon ◽  
R. Lavelle
Keyword(s):  
Hearing Loss ◽  
Otitis Media ◽  
Middle Ear ◽  
Active Drug ◽  
Otitis Media With Effusion ◽  
Therapeutic Benefit ◽  
Double Blind Trial ◽  
Secretory Otitis Media ◽  
Double Blind ◽  
Effusion Fluid

AbstractThe levels of prostaglandian E2 (PGE2) were measured in aspirates of the effusion fluid from children suffering from secretory otitis media. The effects of naproxen 5 mg./kg. twice daily for eight weeks on the condition were studied in a placebocontrolled double-blind trial.Nineteen middle-ear aspiraes from 13 children, six of whom had bilateral aspirations were examined. Detectable levels of PGE2 and those without.In a separate trial of naproxen, 11 patients received active drug and 13 received placebo. Naproxen had no significant effect on otalgia or hearing loss compared to placedo.These findings suggest that is it unlikely that non-steroidal anti-inflammatory drug will be of therapeutic benefit in secretory otitis media.

scholarly journals Otological and audiological manifestations in cleft lip and cleft palate children: a clinical study

2015 ◽  
Vol 1 (1) ◽  
pp. 7 ◽  
Author(s):  
Vijayalakshmi Subramaniam ◽  
Manuprasad S ◽  
Hebin H. Kallikkadan ◽  
Vijay Kumar K
Keyword(s):  
Hearing Loss ◽  
Cleft Palate ◽  
Otitis Media ◽  
Middle Ear ◽  
Cleft Lip ◽  
Otitis Media With Effusion ◽  
Chronic Otitis Media ◽  
Pure Tone Audiometry ◽  
College Hospital ◽  
Orofacial Region

<p class="abstract"><strong>Background:</strong> Cleft lip and cleft palate are the commonest congenital anomalies of the orofacial region. The<strong> </strong>incidence of middle ear problems and hearing loss is reported to be higher in children with cleft palate &amp;/or cleft lip.</p><p class="abstract"><strong>Methods:</strong> A prospective, observational case-control study comprising 80 subjects (40 cases and 40 controls) was undertaken at Yenepoya Medical College Hospital, Mangalore, Karnataka, India. All subjects enrolled were subjected to detailed ENT examination including otoscopy, pure tone audiometry and impedance audiometry.  </p><p class="abstract"><strong>Results:</strong> Retracted tympanic membrane suggestive of Otitis Media with Effusion (OME) and conductive hearing loss was observed in more than 50% of patients with cleft palate &amp;/or cleft lip. Tympanogram of B type suggesting OME was observed in 27% of cases. Chronic otitis media was observed in 32.5% of cases.</p><strong>Conclusions:</strong> The prevalence of OME, Chronic otitis media and hearing loss was observed to be higher among children with cleft palate &amp;/or cleft lip. Otological and audiometric assessment should be performed for all patients having cleft palate &amp;/or cleft lip atleast before surgery in order to facilitate early identification and intervention for middle ear problems particularly middle ear effusion.

Impact of Patient Socioeconomic Disparities on Time to Tympanostomy Tube Placement

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

Determining Otitis Media Severity from Middle Ear Fluid Analysis

1994 ◽  
Vol 103 (5_suppl) ◽  
pp. 43-45 ◽  
Author(s):  
Steven K. Juhn ◽  
William J. Garvis ◽  
Chap T. Le ◽  
Chris J. Lees ◽  
C. S. Kim
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Chronic Otitis Media ◽  
Complex Nature ◽  
Fluid Analysis ◽  
Factor Α ◽  
Necrosis Factor ◽  
Ear Effusion ◽  
Chemical Mediators

Otitis media has a complex multifactorial pathogenesis, and the middle ear inflammatory response is typified by the accumulation of cellular and chemical mediators in middle ear effusion. However, specific biochemical and immunochemical factors that may be responsible for the severity or chronicity of otitis media have not been identified. Identification of factors involved in chronicity appears to be an essential step in the treatment and ultimate prevention of chronic otitis media. We analyzed 70 effusion samples from patients 1 to 10 years of age who had chronic otitis media with effusion for two cytokines (interleukrn-1β and tumor necrosis factor α) and total collagenase. The highest concentrations of all three inflammatory mediators were found in purulent otitis media, and concentrations were higher in younger than in older patients. Mediator concentrations were similar in samples obtained from patients having their first myringotomy for otitis media with effusion and in those who had had multiple previous myringotomies. The multiresponse star, which incorporates several biochemical parameters in one graphic illustration, may best characterize the complex nature of middle ear inflammation.

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