Impact of adenotonsillectomy on hearing profile of children with chronic middle ear effusion

Background: Chronic middle ear effusion (CME) also known as otitis media with effusion (OME)/glue ear/secretory otitis media is the commonest cause of hearing loss in children, characterized by presence of sterile serous fluid within the middle ear, causing temporary and reversible hearing loss. The aim of present investigation was to determine the effect of adenotonsillectomy on hearing profile of children with persistent OME.Methods: This prospective study was conducted in the Department of ENT, Aarupadai Veedu Medical College, Pondicherry during the period of June 2014 to February 2016. 50 children, between the age group of 3-12 years, with features suggestive of OME, and adenotonsillar hypertrophy that underwent adenotonsillectomy during the study period was included in this study. Demographic details and clinical features were collected from the participants. Hearing evaluation was performed by pure tone audiometry (PTA) and tympanometry preoperatively at time of diagnosis and postoperatively at 6 weeks and 3 months after adenotonsillectomy. Data collected was plotted into master chart and analysed using paired t-test and chi square test to determine the improvement in hearing after 6 weeks and 3 months following surgery.Results: 46 children aged between 3 and 12 years with a mean age of 5.3 and standard deviation of 2.2 years. OME was most prevalent in age group was 5-7 years (34.78%) followed by 7-9 years (30.43%). There were 26 (56.52%) males and 20 (43.47%) females. Pre-operatively most of the subjects were having moderate conductive hearing loss (between 26dB to 40dB) with a mean hearing loss of 34.2dB and a standard deviation of 12.2dB. At 6 weeks postoperatively, hearing loss of children were within 16-25dB with a mean loss of 21.6dB and a standard deviation of 6.4dB. At 3 months postoperatively, 30 children were having only minimal hearing loss and 8 were having mild hearing loss.Conclusions: CME is a common cause of childhood hearing loss having a long-term sequel affecting the language development of the child. Adenoidectomy can improve the middle ear function and the hearing profile of child and can be considered as a practical management option in children with chronic adenotonsillar hypertrophy with established otitis media with effusion.

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Impedance Bridge (Tympanometer) As a Screening Device in Schools

PEDIATRICS ◽

10.1542/peds.79.3.472 ◽

1987 ◽

Vol 79 (3) ◽

pp. 472-472

Author(s):

Keyword(s):

Hearing Loss ◽

Middle Ear ◽

Pure Tone ◽

School Health ◽

Otitis Media With Effusion ◽

Pure Tone Audiometry ◽

Middle Ear Effusion ◽

Screening Programs ◽

Ear Effusion ◽

Impedance Bridge

STATEMENT OF PROBLEM There is confusion in schools about the proper use of the impedance bridge. Some groups recommend its use as a substitute for audiometry and suggest physician referral on the basis of an abnormal tympanogram. In our opinion this is inappropriate. BACKGROUND The impedance bridge primarily detects asymptomatic middle ear effusion. This effusion may cause a conductive hearing loss (rarely greater than 20 to 30 dB). There is no consensus as to the advisability of treating this effusion, because it usually remits spontaneously within 2 to 3 months. RECOMMENDATIONS The Committee on School Health recommends that (1) the impedance bridge should not be used in mass screening programs for the detection of hearing loss or middle ear effusion; (2) the impedance bridge may be used in the school setting only as an aid in the diagnosis of individual children who are at high risk for, or who are suspected of having, otitis media with effusion; (3) hearing screening by pure-tone audiometry be used as the primary method of detection of hearing loss in school children; (4) the impedance bridge not be used as a replacement for audiometric screening, because it will not detect sensory neural hearing loss and may lead to overreferral of children with asymptomatic middle ear effusion; (5) any persistent abnormality detected by either the impedance bridge or pure-tone audiometry should result in a prompt referral to the child's pediatrician.

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The management of acute otitis media

Drug and Therapeutics Bulletin ◽

10.1136/dtb.22.14.53 ◽

1984 ◽

Vol 22 (14) ◽

pp. 53-54

Keyword(s):

Hearing Loss ◽

Otitis Media ◽

Clinical Examination ◽

Middle Ear ◽

Acute Otitis Media ◽

Infectious Complications ◽

Middle Ear Effusion ◽

Suppurative Otitis Media ◽

Painful Condition ◽

Ear Effusion

Acute suppurative otitis media (AOM) is a common, painful condition affecting 20% of children under 4 years at least once a year,1 and perhaps more in infancy when clinical examination is most difficult. Infectious complications such as mastoiditis, meningitis and cerebral abscess are now rare, but chronic middle ear effusion and hearing loss remain common. Hearing loss may persist long after the infective episode,2 and may impair learning.

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To Tube or Not to Tube: That Continues to Be the Question

PEDIATRICS ◽

10.1542/peds.76.2.332a ◽

1985 ◽

Vol 76 (2) ◽

pp. 332-332

Author(s):

DAVID W. TEELE ◽

BERNARD ROSNER ◽

JEROME O. KLEIN

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Middle Ear Effusion ◽

Speech And Language ◽

Clinically Significant ◽

Ear Effusion

In Reply.— We appreciate Chamberlin's thoughtful comments about the associations between otitis media with effusion and development of speech and language and his concern about results that are statistically significant but may not be "clinically significant." We share his view that measurements of the sequelae of disease should include those that are meaningful to the child. We reported results of tests of speech and language that indicated that children who had spent many days with middle ear effusion during the first years of life scored significantly lower than did children who had not spent such time.

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Efficacy of medical treatment as an adjunct to surgery in the treatment of secretory otitis media

The Journal of Laryngology & Otology ◽

10.1017/s0022215100101124 ◽

1986 ◽

Vol 100 (12) ◽

pp. 1347-1350 ◽

Cited By ~ 8

Author(s):

T. H. J. Lesser ◽

M. I. Clayton ◽

D. Skinner

Keyword(s):

Medical Treatment ◽

Otitis Media ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Randomised Trial ◽

Control Group ◽

Middle Ear Effusion ◽

Secretory Otitis Media ◽

Ear Effusion

AbstractIn a pilot controlled randomised trial of 38 children who had bilateral secretory otitis media, with effusion demonstrated at operation, we compared the efficacy of a six-week course of an oral decongestant—antihistamine combination and a mucolytic preparation with a control group in preventing the presence of middle-ear effusion six weeks after myringotomy and adenoidectomy. The mucolytic preparation decreased the presence of middle-ear effusion when compared to the decongestant-antihistamine combination and the control group (p=0.06).

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Experimental Otitis Media With Effusion Induced by Middle Ear Effusion

The Laryngoscope ◽

10.1288/00005537-199209000-00014 ◽

1992 ◽

Vol 102 (9) ◽

pp. 1037???1042 ◽

Cited By ~ 9

Author(s):

Junko Nakata ◽

Masashi Suzuki ◽

Hideyuki Kawauchi ◽

Goro Mogi

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Middle Ear Effusion ◽

Ear Effusion

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Experimental Otitis Media with Effusion following Middle Ear Inoculation of Nonviable H Influenzae

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948409300113 ◽

1984 ◽

Vol 93 (1) ◽

pp. 52-56 ◽

Cited By ~ 83

Author(s):

Thomas F. DeMaria ◽

David J. Lim ◽

Bruce R. Briggs ◽

Nobuhiro Okazaki

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Animal Experiment ◽

Otitis Media With Effusion ◽

Type B ◽

Negative Bacterium ◽

Middle Ear Effusion ◽

Sterile Saline ◽

Inflammatory Changes ◽

Ear Effusion

In order to test the hypothesis that nonviable bacteria can induce middle ear inflammation leading to persistent middle ear effusion (MEE), we conducted an animal experiment using formalin-killed Hemophilus influenzae, the bacterium reported to be the most common pathogen isolated from chronic MEEs. Over 70% of the chinchillas injected with formalin-killed H influenzae type b or a nontypeable isolate developed sterile, straw-colored serous MEEs, and exhibited histological evidence of extensive inflammatory changes of the middle ear mucosal connective tissue and epithelium. Control animals injected with pyrogen-free sterile saline did not exhibit any inflammatory changes or effusions in the middle ears. Our data suggest that endotoxin on the surface of H influenzae, a gram-negative bacterium, may be responsible for the induction of the otitis media with effusion. It is suggested that endotoxin (even when the organisms are no longer viable) may be responsible for the production of serous MEE and inflammatory changes in the middle ear.

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IL-5 and Eotaxin Levels in Middle Ear Effusion and Blood from Asthmatics with Otitis Media with Effusion

Acta Oto-Laryngologica ◽

10.1080/0036554021000028117 ◽

2003 ◽

Vol 123 (3) ◽

pp. 383-387 ◽

Cited By ~ 35

Author(s):

Manabu Nonaka ◽

...

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Middle Ear Effusion ◽

Ear Effusion

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The Role of Coagulase-Negative Staphylococci in Chronic Otitis Media With Effusion

Otolaryngology ◽

10.1177/019459988209000628 ◽

1982 ◽

Vol 90 (6) ◽

pp. 837-843 ◽

Cited By ~ 10

Author(s):

Joel M. Bernstein ◽

Diane Dryja ◽

Erwin Neter

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Chronic Otitis Media ◽

Antibiotic Sensitivity ◽

Middle Ear Effusion ◽

Coagulase Negative Staphylococci ◽

Heterogenous Group ◽

Ear Effusion

Twenty-eight middle ear effusions from 27 patients with chronic otitis media with effusion were studied for the presence of bacteria. The most common isolates were coagulase-negative staphylococci. However, biochemical and antibiotic sensitivity patterns demonstrated that these organisms represented a heterogenous group. At least three subtypes of coagulase-negative staphylococci were identified from the middle ear effusions, and in only one instance was the isolate from the ear canal identical with that of the middle ear effusion. The data presented suggest that coagulase-negative staphylococci from the middle ear effusions may not be contaminants; however, it cannot be determined from this study whether these organisms play a role as pathogens or as the result of indolent colonization.

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Tympanostomy Tube Selection: A Review of the Evidence

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1259 ◽

2016 ◽

Vol 7 (1) ◽

pp. 17-22

Author(s):

Ho Sandra ◽

David J Kay

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Acute Otitis Media ◽

The United States ◽

Tube Placement ◽

Tympanostomy Tube ◽

Middle Ear Effusion ◽

Surgeon Experience ◽

Ear Effusion

ABSTRACT Tympanostomy tube (TT) insertion for ventilation of the middle ear is one of most commonly performed procedures in the United States. Indications for tube insertion include otitis media with effusion, recurrent acute otitis media, hearing loss caused by middle ear effusion and persistent acute otitis media. In general, TTs are divided into two categories, short-term tubes and long-term tubes. Depending on the indications for tube placement and surgeon experience with the TT, different tubes can be used. A myriad of tubes have been created since their first documented use in 1845 in attempts to provide better middle ear ventilation, improve ease of placement and prevent complications, such as post-tube otorrhea, persistent perforation and tube occlusion. In order for a tube to be effective, it should be biocompatible with the middle ear to minimize a foreign body reaction. Teflon and silicone remain two of the most commonly used materials in TTs. In addition, the tube design also plays a role for insertion and retention times of TTs. Lastly, TTs can also be coated with various substances, such as silver-oxide, phosphorylcholine and more recently, antibiotics and albumin, in order to prevent biofilm formation and decrease the rate of post-TT otorrhea. Persistent middle ear effusion affects many children each year and can impact their quality of life as well as hearing and language development. With nearly 1 out of every 15 children by the age of 3 years receiving TTs, it is imperative that the right tube be chosen to facilitate optimal ventilation of the middle ear while minimizing complications. How to cite this article Ho S, Kay DJ. Tympanostomy Tube Selection: A Review of the Evidence. Int J Head Neck Surg 2016;7(1):17-22.

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