Efficacy of tympanostomy tube insertion for otitis media with effusion in children with Down syndrome.

OBJECTIVE: Although the insertion of tympanostomy tubes is regarded as an effective treatment for otitis media with effusion in the general population, it remains to be determined whether tympanostomy tube insertion is also effective for otitis media with effusion in children with Down syndrome. The present study was carried out to determine the efficacy of tympanostomy tube insertion in children with Down syndrome. PATIENTS AND METHODS: We studied 28 children (18 males and ten females) with Down syndrome and 28 age-matched control children who underwent tympanostomy tube insertion and were followed up for more than 2 years, up to 7 years of age or older. The children were followed up every month for 6 months after the operation and every 2 months thereafter. The tympanostomy tubes were not removed unless granulation tissue appeared around the ventilation tubes. RESULTS: The cure rate for otitis media with effusion was lower in the children with Down syndrome than in the age-matched control children. Sequelae of otitis media with effusion (atelectatic eardrum, permanent perforation of the eardrum and middle ear cholesteatoma) were significantly often encountered in the former group. The children with Down syndrome had more frequent episodes of otorrhea from the tympanostomy tubes than the control children and antibiotic-resistant-bacteria were frequently isolated. Moreover, improvement in hearing acuity after the placement of tympanostomy tubes was not always achieved in children with Down syndrome. CONCLUSION: The efficacy of the tympanostomy tube insertion for children with Down syndrome was much lower than in control children. We propose that in children with Down syndrome conservative management should be the treatment of first choice and that the insertion of tympanostomy tubes should be indicated only when hearing loss due to middle ear effusion is in a severe degree and when pathological changes of the eardrum, such as adhesion and deep retraction pocket formation, are going to occur.     

Quality-of-life outcomes after surgical intervention for otitis media

OBJECTIVE: To assess the change in disease-specific quality of life in children with recurrent acute otitis media and/or chronic otitis media with effusion treated with surgical intervention. DESIGN: Prospective questionnaire-based outcome study. SETTING: An academic pediatric otolaryngology practice. PARTICIPANTS: Consecutive series of 123 children referred for surgical treatment of recurrent acute otitis media and/or chronic otitis media with effusion. INTERVENTION AND METHODS: Surgery included bilateral myringotomy and tympanostomy tube placement either alone or with adenoidectomy. An otitis media disease-specific questionnaire was administered before and after surgical intervention. MAIN OUTCOME MEASURES: Comparison of the mean percentage change in total ear symptom score between presurgery and postsurgery scores at 1 and 6 months after surgery. RESULTS: The mean percentage change in total ear symptom score was a 74.5% improvement (P<.001) at the 1-month follow-up and a 59.8% improvement (P<.001) at the 6-month follow-up. Parental worry related to the child's ear problems was also significantly decreased, with a mean otitis media disease-specific questionnaire score of 3.43 (P<.001) at 1 month and 2.64 (P<.001) at 6 months after surgery. When caregivers were asked if they would have their child undergo tympanostomy tube placement if they had to make the decision again, 91% and 84% responded yes at the 1- and 6-month follow-up, respectively. CONCLUSIONS: The disease-specific quality of life of children with recurrent acute otitis media and/or chronic otitis media with effusion with appropriate surgical indications significantly improved after surgical intervention. The amount of parental worry concerning their children's ear problems also significantly improved following surgery, and most caregivers would opt again for tube placement.     

Passive smoking after tympanostomy and risk of recurrent acute otitis media

OBJECTIVE: Exposure to environmental tobacco smoke has been reported to be a risk factor for childhood otitis media. The effect of parental smoking on the risk of otitis media after the insertion of tympanostomy tubes is unknown. We evaluated the effect of parental smoking on the risk of recurrent otitis media in children who had received tympanostomy tubes. METHODS: We enrolled 217 children aged 1-4 years who underwent insertion of tympanostomy tubes because of middle ear disease. The children were followed-up for 12 months. Otitis media episodes were recorded in patient diaries by primary care physicians. Parental smoking habits were assessed by a questionnaire at the start of the trial and after the 12 month follow-up had ended. The main outcome measure was risk of recurrent otitis media as defined by four or more otitis media episodes after tympanostomy. Altogether 198 children completed the follow-up. RESULTS: Maternal smoking was associated with a highly increased risk of recurrent acute otitis media (OR 4.15, 95% CI 1.45-11.9) after the insertion of tympanostomy tubes. CONCLUSION: Exposure to passive smoking is associated with four-fold risk of recurrent otitis media after tympanostomy. This finding should be used to encourage parents to stop smoking even after the insertion of tympanostomy tubes to their children.     

Predictors of chronic suppurative otitis media in children

OBJECTIVE: To determine which factors predict development of chronic suppurative otitis media (CSOM) in children. DESIGN: Case-control study, with univariate and multivariate logistic regression analysis applied to determine which factors independently predict CSOM. SUBJECTS: Prognostic factors for CSOM were identified in (1) 100 children with CSOM and 161 controls aged 1 to 12 years and (2) 83 children who developed CSOM in the presence of a tympanostomy tube and 136 children with tympanostomy tubes who did not develop CSOM. RESULTS: Independent predictors for CSOM were previous tympanostomy tube insertion (odds ratio [OR], 121.4 [95% confidence interval {CI}, 38.9-379.3]); having had more than 3 upper respiratory tract infections in the past 6 months (OR, 12.2 [95% CI, 3.5-42.3]); having parents with a low education level (OR, 14.1 [95% CI, 2.9-68.6]); and having older siblings (OR, 4.4 [95% CI, 1.6-12.6]). Independent predictors for CSOM after tympanostomy tube insertion were having experienced more than 3 episodes of otitis media in the past year (OR, 4.9 [95% CI, 2.2-11.0]; attending day care (OR, 3.6 [95% CI, 1.7-7.8]); and having older siblings (OR, 2.6 [95% CI, 1.2-5.5]). CONCLUSIONS: Treatment with tympanostomy tubes is the most important prognostic factor for CSOM in children. In children who are being treated with tympanostomy tubes for persistent middle ear effusion, the most important prognostic factor for CSOM is a history of recurrent episodes of acute otitis media. This information should be taken into consideration and discussed with parents when considering insertion of tympanostomy tubes in children.     

The feasibility of office-based laser-assisted tympanic membrane fenestration with tympanostomy tube insertion: the duPont Hospital experience.

OBJECTIVE: To determine the feasibility of inserting tympanostomy tubes in children using office-based laser-assisted tympanic membrane fenestration. METHODS AND MATERIALS: Study consisted of a retrospective review of the charts of all children who underwent office-based laser-assisted tympanic membrane fenestration with tympanostomy tube insertion from July 1, 1998 to August 31, 2000. Tetracaine eardrops were used for topical anesthesia. Fenestration was achieved with the OtoLAM flashscanner laser (ESC Sharplan, Yokneam, Israel). RESULTS: Of the 127 patients (185 ears) who underwent laser-assisted tympanic membrane fenestration, 61 ears underwent tympanostomy tube insertion. Ten ears were treated for otitis media with effusion, 43 for recurrent acute otitis media, and eight for acute otitis media not responding to antibiotics. Fifteen ears had purulent effusion, five had a serous effusion, and 23 had mucoid middle ear fluid. Eighteen ears had no middle ear fluid. At the first follow-up visit, all tested ears had hearing of 20 dB or better. Two children had tubes that were blocked. Blockage occurred in ears that required more than one laser firing to penetrate the tympanic membrane. Otorrhea was present in 13 ears (21%). Otorrhea occurred exclusively in ears with purulent or mucoid middle ear fluid. CONCLUSIONS: Office-based laser-assisted tympanic membrane fenestration with tympanostomy tube insertion is a safe and effective alternative to tube placement in the operating room. The outcome compares favorably with previously published data.     

Prevention of recurrent acute otitis media: chemoprophylaxis versus tympanostomy tubes

Otitis media has long been recognized as one of the most common diseases of childhood. Several therapeutic modalities have been advocated for the prevention of recurrent episodes of acute otitis media (AOM). A blinded, prospective, randomized study was designed to determine the efficacy of tympanostomy tubes, antibiotic prophylaxis, and placebo. Children with recurrent AOM were entered in the study and followed for at least 6 months. A total of 65 children completed the protocol. Sixty-three of those were under the age of 4 years. Treatment failure was defined as two or more episodes of AOM or otorrhea in less than 3 months. Five of 22 children in the tympanostomy tube group failed, compared to 12 of 20 in the placebo group (p = .02). There were 8 or 21 treatment failures in the sulfisoxazole group. Children with otitis media with effusion (OME) at the time of their initial visit had significantly less middle ear disease when treated with tympanostomy tubes. Tympanostomy tube insertion for prophylaxis of recurrent acute otitis is supported by these findings. Improvement of recurrent AOM was observed in the sulfisoxazole group, but was not statistically significant.     

Sex distribution in children with tympanosclerosis after insertion of a tympanostomy tube

Tympanostomy tube insertion is an accepted treatment for otitis media with effusion in children. Several clinical studies have shown that tube insertion may cause myringosclerosis. During the period 1988 to 1997 we treated 533 ears from 311 children who had otitis media with effusion by inserting tympanostomy tubes. Most of these (431 ears from 251 children) were re-examined in 1998 and sex and occurrence of myringosclerosis at the tube insertion site were noted. Myringosclerosis was observed in 31% of ears of girls treated with tubes, whereas in boys 71% of ears showed myringosclerosis. This difference between sexes may indicate a genetic predisposition such as that seen in atherosclerosis. Received: 8 May 2000 / Accepted: 29 September 2000     

A 14-year prospective follow-up study of children treated early in life with tympanostomy tubes: Part 2: Hearing outcomes

OBJECTIVE: To determine hearing outcomes in young children receiving early and repeated tympanostomy tube insertion for recurrent acute otitis media or otitis media with effusion. DESIGN: Prospective 14-year follow-up. SETTING: Central Hospital of Central Finland, a tertiary care hospital.Patients Three hundred five consecutive infants and young children with otitis media received initial tympanostomy tube insertion at the age of 5 to 16 months. The final study group comprised 237 patients (77.7%) attending the 14-year checkups. MAIN OUTCOME MEASURES: At the 14-year checkups, children received clinical examinations and audiometric testing for the determination of bone and air conduction pure-tone thresholds. RESULTS: The mean pure-tone average of 177 healed ears was 4.3 dB. The mean pure-tone average of all ears was 5.8 dB, with significantly poorer results in ears with abnormal outcomes such as grade II or higher pars tensa retraction, otitis media with effusion, and tympanic membrane perforation. Thirteen (5.5%) of 237 ears had a hearing level worse than 15 dB, and the better ear hearing level was poorer than 15 dB in 3 patients. CONCLUSIONS: The hearing level of healed ears was comparable to that of age-matched normal ears. Hearing losses were infrequent, of slight grade, and, when present, almost exclusively conductive and related to unsuccessful otological outcomes. From the hearing point of view, repeated tympanostomy tube insertion for recurrent acute otitis media or otitis media with effusion early in life is a safe treatment.     

局麻下咽鼓管球囊扩张术加鼓膜置管术治疗顽固性分泌性中耳炎

目的：探讨局麻下咽鼓管球囊扩张术加鼓膜置管术治疗顽固性分泌性中耳炎的临床疗效。方法收集顽固性分泌性中耳炎患者20例（24耳）,于门诊局麻下,结合鼻内镜经鼻腔径路行咽鼓管咽口球囊扩张,并行鼓膜置管。所有患者均于术后3个月拔出T型管。结果术后随访6个月,18例患者耳闷塞感、听物朦胧感症状明显减轻,未再出现鼓室内积液。2例术后仍有耳内闷胀及听力下降,耳内镜检查示鼓室积液未吸收,再次置入T型通气管后症状改善。结论局麻下行咽鼓管球囊扩张术加鼓膜置管术治疗顽固性分泌性中耳炎疗效显著,对于改善咽鼓管功能方法安全可行,并发症极小,是一种微创的新方法。     

Prevention of otitis media by adenoidectomy in children younger than 2 years

OBJECTIVES: To test the effect of adenoidectomy in connection with tympanostomy compared with tympanostomy only in preventing otitis media in children younger than 2 years. DESIGN: Prospective trial with randomized and nonrandomized arms. SETTING: Primary care study clinics. PARTICIPANTS AND INTERVENTIONS: The study participants were selected from 2497 children who had been enrolled in the Finnish Otitis Media Vaccine Trial at the age of 2 months. A total of 306 children, aged 1 to 2 years, who had experienced recurrent episodes of otitis media were randomized into 2 treatment groups: tympanostomy with or without adenoidectomy. Of the 306 children, 137 were operated on according to random basis (randomized trial). The 169 children whose parents declined participation in the randomized trial were operated on according to the parents' preferences (nonrandomized trial). All children were followed up until 2 years of age. The mean follow-up time was 7 months. MAIN OUTCOME MEASURE: The rate of acute otitis media episodes. RESULTS: The average reduction in the rate of all acute otitis media episodes in the adenoidectomy group was 19% (95% confidence interval [CI], -14% to 43%) among children enrolled in the randomized trial and 25% (95% CI, -13% to 50%) in the nonrandomized trial. The reduction in the randomized trial was mainly due to reduction in the rate of pneumococcal otitis media (58%, 95% CI, 16%-79%). CONCLUSION: In children younger than 2 years, concurrent adenoidectomy during the insertion of tympanostomy tubes does not seem to have a major advantage over the insertion of tympanostomy tubes alone in preventing otitis media.     

Microbiologic findings and risk factors for antimicrobial resistance at myringotomy for tympanostomy tube placement--a prospective study of 601 children in Toronto

CONTEXT: There is limited information on the identity and antibiotic susceptibility of bacterial pathogens in children with chronic otitis media whose repeated antibiotic use may place them at increased risk of antibiotic-resistant bacteria. OBJECTIVE: To determine, at myringotomy for tympanostomy tube placement, (1) the prevalence of bacteria, (2) the extent and patterns of antibiotic resistance, and (3) the risk factors associated with the presence and resistant status of pathogens. DESIGN: Prospective, multi-site, cohort study. SETTING AND PATIENTS: Children undergoing myringotomy for tympanostomy tube placement between November 1, 1999 and March 31, 2000 in seven hospitals in Toronto, Ontario, were identified. If fluid was present, aspirates were submitted for bacteriologic testing. A follow-up telephone questionnaire was administered to patient caregivers in order to identify risk factors for the presence of (1) culturable pathogens and (2) resistant pathogens. MAIN OUTCOME MEASURES: The identification and prevalence of bacteria cultured from the middle ears of subjects, and the degree of nonsusceptibility to commonly prescribed antibiotics. RESULTS: Among 601 patients (mean age 3.9 years, 60.7% male), both a telephone interview (n=544) and an ear specimen (n=527) were obtained for 478. Pathogens were found in middle ear effusions of 37% of the children in the study; including at least one 'definite' pathogen in 189 children (31.4%), and a further 32 children (5.3%) with at least one 'possible' pathogen. Definite pathogens included Haemophilus influenzae in 17% of the children, followed by Moraxella catarrhalis (9%) and Streptococcus pneumoniae (6%); ampicillin nonsusceptibility was found in 40, 100 and 24%, respectively. Overall, 123 children (20.5%) were found to have definite pathogens with resistance to ampicillin/penicillin, trimethoprim-sulfamethoxazole, or clarithromycin/erythromycin. Patient characteristics included premature birth and/or long length of stay in the nursery (23%), first infection before the age of 6 months (26%), put to bed with a bottle (28%), household smoker (34%), in out-of-home child care (38%), history of eczema, bronchiolitis and/or asthma (39%), and use of pacifiers (40%). Household characteristics were smoking (34%), married/common law parents (85%), and 60% had completed college or university; in 26% both parents were born outside of Canada; 73% of children were Caucasian. Of the 75% who responded to the question regarding income, 42% had household income over $60,000 (CAN). Risk factors for the presence of a pathogen and for a resistant pathogen in multivariate analysis included younger age, lower maternal education, day care centre attendance, no previous adenoidectomy and bilateral, primarily winter infections as well as amoxicillin use in the previous 6 months. CONCLUSION: Modifiable risk factors for otitis media including household smoking and pacifier use are present in many children undergoing tympanostomy tube placement; child care centre attendees are over-represented. Multiple antibiotic courses were commonly prescribed prior to surgery. H. influenzae and M. catarrhalis are important pathogens and therapy in clinical failures should be directed against them. The 7-valent protein conjugate polysaccharide vaccine (Prevnar) would have covered 73% of the serotypes of S. pneumoniae isolated in this study.     

The relationship between repeat tympanostomy tube insertion and adenoidectomy

Objectives

To examine the relationship between adenoidectomy and repeat tympanostomy tube placement in the treatment of otitis media, and the relationship between potential risk factors for otitis media and repeat tympanostomy tube placement.

Methods

Retrospective, cross-sectional analysis of consecutive patients undergoing tympanostomy tube placement at an academic/teaching hospital with 400+ beds. Utilizing an electronic billing database, patients less than 18 years of age undergoing tympanostomy tube placement between January 1, 2000 and December 31, 2007 were identified. Information regarding initial and repeat tympanostomy tube placement as well as potential risk factors for otitis media were extracted from medical records.

Results

904 children were included in the study. Of the 780 children who initially underwent tympanostomy tube placement alone, 178 required additional tube placement; a repeat rate of 20%. Of the 90 children who initially underwent tympanostomy tube placement with adenoidectomy, only 6 required repeat tube placement, a statistically significant decrease in the incidence of repeat tympanostomy tube placement (95% CI, 0.056–0.334; p < 0.0001). The presence of craniofacial anomalies and day care/school attendance were significantly associated with additional tube placement. Children between the ages of 4 and 10 showed a significant (p < 0.0001) decrease in the risk of repeat tube placement when an adenoidectomy was performed at the initial tube placement.

Conclusion

Adenoidectomy performed at the first tympanostomy tube for the treatment of otitis media may decrease the risk of repeat tube placement, especially for children >4–10 years of age.     

Effect of 23 valent pneumococcal polysaccharide and Haemophilus influenza conjugated vaccines on the clinical course of otitis media with effusion

Objective To determine if there is any clinical effect of 23‐valent pneumococcal and Haemophilus influenza type B conjugate vaccine on prognosis of otitis media with effusion. Method All children who have middle ear effusion despite long‐standing antibiotherapy with a beta lactamase stable agent were offered for tympanostomy tube insertion between February 1999 and December 2001. Patients who accepted the surgical intervention were operated under general anesthesia and a Shepard grommet‐type tympanostomy tube was inserted. Those who refused the surgical intervention were vaccinated with 23‐valent pneumococcal and Haemophilus influenza type B conjugate vaccine. State of the middle ear effusion was evaluated at the end of the 12th month in the vaccine group and 1 month after the myringotomy site was healed in the tympanostomy tube insertion group. Results Twenty‐six children in the vaccine group and 37 children in the tympanostomy tube insertion group proved the inclusion criteria at the end of study. Complete or partial resolution of middle ear effusion was observed in 73.1% of 26 children in the vaccine group and 59.5% of children in the tympanostomy tube insertion group. There was no significant difference between the two groups. Conclusion Vaccination against Streptococcus pneumonia and Haemophilus influenza type b seems to aid resolution of middle ear effusion in children with otitis media with effusion.     

Compare two surgical interventions for otitis media with effusion in young children

European Archives of Oto-Rhino-Laryngology - To prospectively evaluate the effect of tympanostomy tubes combined with adenoidectomy and tube insertion on treatment for otitis media with effusion in...     

Myringotomy with and without tympanostomy tubes for chronic otitis media with effusion

We studied 109 children with otitis media with effusion of 2 months' duration or longer that was unresponsive to medical management. Eighty-six subjects who had neither "significant" hearing loss nor defined symptoms were randomly assigned to receive myringotomy, myringotomy with tympanostomy tube insertion, or no surgery, and 23 subjects with significant hearing loss, defined symptoms, or both were randomly assigned to receive either myringotomy or myringotomy with tube insertion. Myringotomy with tube insertion provided more disease-free time and better hearing than either myringotomy alone or no surgery; however, some subjects who underwent myringotomy with tube insertion developed otorrhea or persistent perforation of the tympanic membrane. Myringotomy offered no advantage over no surgery regarding percent of time with middle-ear effusion, number of acute otitis media episodes, and number of subsequent surgical procedures. These results may not properly be extrapolated to less severely affected children.     

Management of recurrent acute otitis media in children: systematic review of the effect of different interventions on otitis media recurrence, recurrence frequency and total recurrence time

Objective: To conduct a systematic review comparing the effect of three interventions (prophylactic antibiotics, tympanostomy tube insertion and adenoidectomy) on otitis media recurrence, recurrence frequency and total recurrence time. Methods: Literature on recurrent otitis media was identified using the PubMed and Scopus search engines for the period January 1990 to March 2011. A hand search of the reference lists of relevant articles and textbooks was conducted to identify additional studies. Randomised, controlled trials with a minimum of 40 children and follow up of at least 12 months were included. Results: Eighteen publications were identified. Each was assessed using preset inclusion criteria; seven publications met these criteria. Conclusion: Prophylactic antibiotics are effective in reducing otitis media recurrence, recurrence frequency and total recurrence time. Tympanostomy tube insertion failed to reduce the prevalence of otitis media recurrence, but reduced the recurrence frequency and total recurrence time. Adenoidectomy reduced otitis media recurrence; results on otitis media recurrence frequency differed but on average there was a reduction; however, the two studies with relevant data on total recurrence time had contradictory results.     

Otorrhea after insertion of silver oxide-impregnated silastic tympanostomy tubes

BACKGROUND: Silver oxide-impregnated tympanostomy tubes have been shown to decrease the incidence of postoperative otorrhea, but without a significant effect in the first postoperative week. OBJECTIVE: To evaluate prospectively our results with silver oxide-impregnated tympanostomy tubes and to identify factors associated with a higher incidence of early postoperative otorrhea. DESIGN: Prospective nonrandomized study. SETTING: University referral center. PATIENTS AND OTHER PARTICIPANTS: Six hundred thirty patients with chronic otitis media with effusion or recurrent otitis media. INTERVENTIONS: Silver oxide-impregnated Silastic tympanostomy tubes were inserted in 1254 ears. Subjects with mucoid or purulent effusions or blood at the myringotomy site at surgery were treated with topical antibiotic prophylaxis (sulfacetamide sodium-prednisolone acetate or neomycin sulfate-polymyxin B sulfate-hydrocortisone) for 5 days after tympanostomy tube placement. MAIN OUTCOME MEASURES: Incidence of otorrhea after tympanostomy tube insertion at 1 week and 1, 3, 6, 9, and 12 months after surgery. RESULTS: The overall incidence of postoperative otorrhea was 1.9%. The incidence of otorrhea in the first postoperative week was 5.6%; the incidence of otorrhea after the first postoperative week was 1.2% (P<.001). Within the first postoperative week, a significantly greater incidence of otorrhea was noted in patients younger than 3 years (7.8%), in patients with mucoid effusions at surgery (8.6%), and in patients younger than 3 years with mucoid effusions at surgery (15.2%). CONCLUSIONS: Silver oxide-impregnated tympanostomy tubes are associated with a low overall incidence of postoperative otorrhea. A significantly higher incidence of otorrhea is seen during the first postoperative week, compared with the incidence after the first week. Patients with thick middle ear effusions and age younger than 3 years have a significantly greater incidence of early otorrhea after tympanostomy tube placement.     

Phenol as an adjuvant anesthetic for tympanostomy tube insertion

The use of inhalational anesthesia for insertion of tympanostomy tubes in children provides no postoperative pain relief. Our retrospective analysis of children following tympanostomy tube insertion previously had shown significant postoperative elevations of blood pressure and heart rate in over 70% of cases. These changes, along with behavioral findings and complaints of discomfort, are suggestive of pain. Phenol has been used in adults for local anesthesia during tympanostomy tube insertion. This study determined prospectively whether pain occurred postoperatively and whether phenol placed on the tympanic membrane just prior to myringotomy would reduce postoperative pain in children, as measured by behavioral and physiologic parameters. Results of a double-blind, randomized trial in 46 children showed that both the phenol-treated and the control groups demonstrated significant elevations in pain scores postoperatively (P = 0.0001), which then slowly diminished to baseline by 45 min to one hour. The phenol group had consistently higher pain scores than the non-phenol group (P less than 0.001). Possible reasons for these findings are discussed.     

咽鼓管球囊扩张术治疗慢性分泌性中耳炎的短期疗效观察

目的 观察咽鼓管球囊扩张术联合鼓膜切开置管治疗慢性分泌性中耳炎的短期疗效。 方法 对2014年8月至2016年12月诊断为慢性分泌性中耳炎并入院接受咽鼓管球囊扩张术联合鼓膜切开置管术治疗的19例21耳行短期疗效观察分析。评价的指标如下:纯音电测听气导均值(PTA)、气-骨导差(ABG)、声阻抗、耳内镜检查、颞骨CT扫描和主观满意度(VAS视觉模拟评分)。 结果 19例均于全麻下顺利完成手术,术后6个月鼓膜置管未脱落者予以取管。术后随访6~10个月,纯音电测听测试耳气导结果术后较术前有所提高。PTA从术前(59.5±21.5)dBHL降低到术后(52.0±31.0)dBHL(t=3.409, P=0.005), ABG从术前(35.5±17.5)dBHL降低到术后(21±16)dBHL(t=2.957,P=0.011), 76.19%的患者声阻抗鼓室图术后转为A型;3例5耳自觉听力和症状无明显改善,其中2例4耳鼓室积液持续存在,1例1耳取管后3周再次复发,予以持续置管。术后疗效满意度平均为(6.17±1.16)分。 结论 咽鼓管球囊扩张术联合鼓膜切开置管治疗慢性分泌性中耳炎短期疗效好。     

Quality of life outcomes after ventilating tube insertion for otitis media in an Australian population

OBJECTIVE: To assess the change in quality of life in a group of Australian children with recurrent acute otitis media (AOM) and/or otitis media with effusion (OME) who were treated with ventilating tube (VT) insertion. METHODS: Prospective pre- and post-intervention outcome study at the Women's and Children's Hospital, North Adelaide, South Australia. The Otitis Media 6-item (OM-6) survey was used as a measure of disease-specific quality of life prior to surgery and then again at 6 weeks post-operatively. Any patients who were listed for any additional ear, nose or throat (ENT) procedures at the same time were excluded. RESULTS: Complete responses for both pre- and post-surgery questionnaires were obtained from the parents of 53 patients. The age range was 11 months to 15.4 years (average 5.1 years), and 39.6% (n=21) were suffering from recurrent AOM whilst the remaining 60.4% (n=32) were suffering from OME. Overall ear-related quality of life was found to improve significantly following insertion of ventilating tubes (p<0.001), as was the mean OM-6 score (p<0.001). Furthermore, statistically significant improvements were noted in each individual domain making up the OM-6 survey (physical suffering, hearing loss, speech impairment, emotional distress, activity limitations and caregiver concerns). CONCLUSIONS: The disease-specific quality of life of a group of Australian pediatric patients with otitis media was found to significantly improve following insertion of ventilating tubes as measured by the OM-6 survey. Improvements were found in global ear-related quality of life, in the mean OM-6 score, as well as in all individual domains of the OM-6 survey.