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.

Eustachian Tube Ventilatory Function in Children

1976 ◽  
Vol 85 (2_suppl) ◽  
pp. 171-177 ◽  
Author(s):  
Erdem I. Cantekin ◽  
Charles D. Bluestone ◽  
Leon P. Parkin
Keyword(s):  
Tympanic Membrane ◽  
Eustachian Tube ◽  
Middle Ear ◽  
Chronic Otitis Media ◽  
Response Characteristic ◽  
Ventilatory Function ◽  
Stimulus Response ◽  
Tympanostomy Tubes ◽  
History Of ◽  
Middle Ear Disease

In order to establish a simple stimulus-response characteristic of Eustachian tube physiology in children, the tubal ventilatory function was studied. The parameters of active and passive opening of the tube were measured for three groups of patients with non-intact tympanic membranes. The group with traumatic perforations of the tympanic membrane without any history of middle ear disease had better active equilibration function than the group with chronic otitis media and perforations of the tympanic membrane and the group with tympanostomy tubes in the tympanic membrane. Quantitatively, this could be expressed in terms of residual positive pressures. In the study of repeated inflation of the middle ear, all groups had lower second opening pressures which are attributed to the effect of surface forces.

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.

Efficacy of Acoustic Reflectometry in Detecting Middle Ear Effusion

1986 ◽  
Vol 95 (5) ◽  
pp. 472-476 ◽  
Author(s):  
Christine A. Avery ◽  
George A. Gates ◽  
Thomas J. Prihoda
Keyword(s):  
Tympanic Membrane ◽  
Otitis Media ◽  
Sensitivity And Specificity ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Chronic Otitis Media ◽  
Lower Sensitivity ◽  
Middle Ear Effusion ◽  
Receiver Operator Characteristics ◽  
Ear Effusion

The acoustic otoscope measures the amount of sound reflected from the tympanic membrane. Since the amount of reflected sound is increased by fluid in the middle ear, it seemed likely that the acoustic otoscope could be used for detection of otitis media. We compared acoustic reflectometry with over 4,000 tympanometric and otoscopic examinations in 451 children who were examined at regular intervals following surgery for chronic otitis media with effusion. The data indicate a lower sensitivity and specificity of acoustic reflectometry than had been reported previously. The receiver-operator characteristics of this device are discussed.

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.

Workshop on Effects of Otitis Media on the Child

PEDIATRICS ◽  
1983 ◽  
Vol 71 (4) ◽  
pp. 639-652
Author(s):  
Charles D. Bluestone ◽  
Jerome O. Klein ◽  
Jack L. Paradise ◽  
Heinz Eichenwald ◽  
Fred H. Bess ◽  
...  
Keyword(s):  
Tympanic Membrane ◽  
Otitis Media ◽  
Middle Ear ◽  
Current Knowledge ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Chronic Otitis Media ◽  
Signs And Symptoms ◽  
Middle Ear Effusion ◽  
Ear Effusion

GOALS, DEFINITIONS, AND CLASSIFICATION OF OTITIS MEDIA —Charles D. Bluestone, MD The goal of this Workshop was to assess current knowledge concerning the effects of otitis media on the child. Experts in pediatrics, infectious disease, otolaryngology, audiology, speech, linguistics, and psychology met in Chicago on Aug 25, 1982 to participate in this Workshop. A summary of the discussions is presented here. Otitis media is broadly defined as an inflammation of the middle ear without reference to etiology or pathogenesis.1 Otitis media with effusion is an inflammation of the middle ear in which a collection of liquid (i.e., middle ear effusion) is present in the middle ear space (no perforation of the tympanic membrane is present). Atelectasis of the tympanic membrane, which may or may not be associated with otitis media, is defined as either collapse or retraction of the tympanic membrane. Acute otitis media implies a rapid and short onset of signs and symptoms lasting approximately 3 weeks. From 3 weeks to 3 months, the process may be resolving or subacute. If middle ear effusion persists beyond 3 months, the condition is classified as chronic otitis media with effusion. Many terms have been used for acute otitis media, such as "suppurative," "purulent," or "bacterial" otitis media; however, a "serous" effusion may also have an acute onset. Otitis media with effusion unaccompanied by signs and symptoms of acute inflammation has also had a plethora of other names: "serous," "secretory," "nonsuppurative," and "glue ear" have been the most commonly used. EPIDEMIOLOGY AND NATURAL HISTORY OF OTITIS MEDIA

scholarly journals An Assistive Role of a Machine Learning Network in Diagnosis of Middle Ear Diseases

2021 ◽  
Vol 10 (15) ◽  
pp. 3198
Author(s):  
Hayoung Byun ◽  
Sangjoon Yu ◽  
Jaehoon Oh ◽  
Junwon Bae ◽  
Myeong Seong Yoon ◽  
...  
Keyword(s):  
Machine Learning ◽  
Tympanic Membrane ◽  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Chronic Otitis Media ◽  
Diagnostic Process ◽  
Ear Diseases ◽  
Learning Network ◽  
Resident Physicians

The present study aimed to develop a machine learning network to diagnose middle ear diseases with tympanic membrane images and to identify its assistive role in the diagnostic process. The medical records of subjects who underwent ear endoscopy tests were reviewed. From these records, 2272 diagnostic tympanic membranes images were appropriately labeled as normal, otitis media with effusion (OME), chronic otitis media (COM), or cholesteatoma and were used for training. We developed the “ResNet18 + Shuffle” network and validated the model performance. Seventy-one representative cases were selected to test the final accuracy of the network and resident physicians. We asked 10 resident physicians to make diagnoses from tympanic membrane images with and without the help of the machine learning network, and the change of the diagnostic performance of resident physicians with the aid of the answers from the machine learning network was assessed. The devised network showed a highest accuracy of 97.18%. A five-fold validation showed that the network successfully diagnosed ear diseases with an accuracy greater than 93%. All resident physicians were able to diagnose middle ear diseases more accurately with the help of the machine learning network. The increase in diagnostic accuracy was up to 18% (1.4% to 18.4%). The machine learning network successfully classified middle ear diseases and was assistive to clinicians in the interpretation of tympanic membrane images.

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.

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%.

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

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