Duration and complications following grommet insertion in childhood

We report 1000 insertions of ventilation tubes in 534 children for secretory otitis media (SOM) within a period of 6 years. In 77.5% of the cases, the air-bone gap was greater than 20 dB. The grommets are allowed to undergo spontaneous expulsion which happened in 319 ears, about 7 months after insertion. SOM recurred in 32.6% of the cases once, in 5.0% of the cases twice, and in 1.9% three times, requiring re-insertion of grommets. Recurrence appeared between 4 and 65 months after the first insertion. In three cases perforations of the tympanic membrane persisted and required tympanoplasty. Tympanometric examination and pure tone audiometry are necessary, in addition to pure tone audiometry to follow up successfully ventilated middle ears and to show recurrence as early as possible. Pre-existing but unsuspected sensorineural hearing loss was discovered in 10 cases. The deprivation of neural auditory pathways in early childhood and the possible retardation of speech development caused by SOM are mentioned. Normal hearing is the most important goal of therapy in children suffering from SOM, and insertion of ventilation tubes is the preferred method of achieving that goal safely. Adenoidectomy and treatment of upper airway infections are indispensable parts of the therapy of SOM. Regular follow up after insertion of grommets and even after their expulsion is necessary because of the high rate of late recurrence of SOM. Induction of cholesteatoma by grommets was not observed.     

The feasibility of recording transiently evoked otoacoustic emissions immediately following grommet insertion

The demonstration of normal hearing following grommet insertion in young or difficult to test children can be problematic. This study aims to determine whether transiently evoked otoacoustic emissions (TEOAEs), can be recorded in the operating theatre, immediately after grommet insertion, and whether this technique has any advantages over conventional testing to exclude sensorineural loss. One ear of each of 80 children was studied, using the Otodynamics ILO88 OAE analyser. Responses were normal in eight, reduced in 31 and absent in 39. Bleeding prevented the performance of the test in two children. We conclude that TEOAEs can be recorded in 50% of ears immediately after grommet insertion, but the responses are reduced compared with normal ears. This application of TEOAEs may be a useful supplement to behavioural tests, but we do not advocate it as a screening technique.     

Is there agreement among general practitioners, paediatricians and otolaryngologists about the management of children with recurrent tonsillitis?

Tonsillectomy is the second most common operation undertaken in children in the United Kingdom, but the rate at which tonsillectomy is performed varies greatly across the Health Authorities. The reasons for the variation appear to be related to differences in local medical practice rather than differences in regional morbidity. This study was undertaken to compare the factors used to diagnose tonsillitis in children, the indications for tonsillectomy and the expected benefits of tonsillectomy in children by general practitioners, paediatricians and otolaryngologists. There was poor correlation between general practitioners, paediatricians and otolaryngologists in all study objectives. There appears to be no consistent clinical pathway by which children with recurrent tonsillitis are managed. The wide variation in tonsillectomy rates across the United Kingdom will probably continue until the decision-making process of doctors involved in the treatment of children with recurrent tonsillitis is better understood.     

How we do it: the Bradford grommet trainer: a model for training in myringotomy and grommet insertion

? Myringotomy and grommet insertion is the most common operative procedure in otological practice. ? We describe a simple, cheap and effective model for the junior trainee to develop the skills required for myringotomy and grommet insertion without compromising patient safety. ? As the materials required for our model are more readily available, it is more likely to gain widespread acceptance in ENT training.     

The effects of grommet insertion on Eustachian tube function

A prospective study on the effect of grommet insertion on the passive Eustachian tube opening pressure was undertaken in children's ears with otitis media with effusion. After an initial immediate improvement following aspiration of the middle ear no further change in Eustachian tube function occurred over 4 subsequent weeks. Grommet insertion probably has no effect on Eustachian tube function.     

鼓室置管术及相关处理治疗小儿分泌性中耳炎

目的 :提高对小儿分泌性中耳炎 (SOM)的诊疗水平。方法 :对 80例 (144耳 )小儿 SOM均行鼓室置硅胶管术 ,其中 30例同时行增殖体刮除和 (或 )扁桃体摘除术、10例行腭裂修复术、2 0例鼻窦炎患者行抗炎引流治疗。结果 :80例患儿随访 0 .5～ 1年 ,83%耳 (6 5例 12 0耳 )听力明显改善 ,纯音听阈 ,声导抗检查恢复正常。结论 :对 SOM的患儿应及时进行综合性治疗 ,方可改善听力。     

Informed consent: questionnaire survey of British otolaryngologists

This postal questionnaire of British otolaryngologists has shown that most strive to obtain true informed consent when recommending surgery. The consent form is usually signed on the ward or at a pre-admission clinic and witnessed by a house officer. One-third of house officers receive no instructions about what to discuss at this time, however, most consultants keep some record of what was discussed. A quarter of surgeons use information sheets, those not using them are more likely to anticipate problems with their use. An assessment of which complications are usually discussed is given. Comparison with a similar study shows increased disclosure of complications, perhaps a more defensive approach in surgical practice is developing.     

The effect of anaesthesia on tympanograms of children undergoing grommet insertion

A prospective study was designed to assess the effect of anaesthesia, including nitrous oxide, on tympanometric results of children undergoing myringotomy and possible grommet insertion. 155 patients (310 ears) were examined with a pneumatic otoscope and had tympanograms performed within 1 hour of operation. The patients were then anaesthetized by a combination of intravenous and gaseous anaesthetic. Immediately before myringotomy, a tympanogram was repeated. In 13% of patients predicted to have fluid at admission, there was a change in their tympanogram after induction of anaesthesia, suggesting clearance of fluid. At myringotomy, these ears were dry. We surmise that there was displacement of fluid from the middle ear by nitrous oxide during the early stages of anaesthesia. Thus we feel that, if an otologist confidently expects to find an effusion at myringotomy, the presence of a dry tap should not change his management plan.     

Antroscopy: current practice--a survey of UK otolaryngologists

The use of antroscopy by otolaryngologists in the UK was assessed by means of a postal questionnaire. A response of 70 per cent was obtained. Thirty-three per cent of otolaryngologists currently perform antroscopy; the principal reason for not using the technique being lack of suitable equipment. Twenty-four per cent of non-users believed that antroscopy would not alter their management of patients, and 19 per cent of all responders thought that antroscopy had no proven clinical role. Few surgeons recognized a role for antroscopy in the treatment of antral disease. Antroscopists preferred to operate on in-patients (73 per cent), under a general anaesthetic (60 per cent) and via the inferior meatus (66 per cent); 76 per cent consider that morbidity is insignificant. There is clearly a need for studies clarifying the role of antroscopy in clinical practice and to establish the cost-effectiveness of the technique.     

Medial displacement of grommets: an unwanted sequel of grommet insertion

Grommet insertion is one of the commonest surgical procedures performed in the UK. We have come across three cases in which grommets have displaced medially in the middle ear after establishing a satisfactory post-insertion position. We suggest that an abnormally long myringotomy incision and improper placement of the grommet are responsible for this unwanted outcome.     

The effect of anaesthesia on tympanograms of children undergoing grommet insertion.

A prospective study was designed to assess the effect of anaesthesia, including nitrous oxide, on tympanometric results of children undergoing myringotomy and possible grommet insertion. 155 patients (310 ears) were examined with a pneumatic otoscope and had tympanograms performed within 1 hour of operation. The patients were then anaesthetized by a combination of intravenous and gaseous anaesthetic. Immediately before myringotomy, a tympanogram was repeated. In 13% of patients predicted to have fluid at admission, there was a change in their tympanogram after induction of anaesthesia, suggesting clearance of fluid. At myringotomy, these ears were dry. We surmise that there was displacement of fluid from the middle ear by nitrous oxide during the early stages of anaesthesia. Thus we feel that, if an otologist confidently expects to find an effusion at myringotomy, the presence of a dry tap should not change his management plan.     

Current management of necrotising otitis externa in the UK: survey of 221 UK otolaryngologists

Introduction: Necrotising otitis externa (NOE) is a rare infection causing skull base osteomyelitis. The evidence regarding NOE consists mostly of case series. Hence, there is a limited evidence base to guide decision-making. This survey aims to report the experience of 221 otolaryngologists in this condition.

Materials and methods: Internet survey administered to the membership of the British Association of Otorhinolaryngology – Head and Neck Surgery (ENT UK).

Results: Respondents’ detailed replies on diagnosis, treatment and follow up are presented. One third of respondents reported increasing incidence of NOE. Over 80% diagnosed NOE based on pre-existing risk factors, severe pain, non-resolution of infection and CT scan. Most respondents managed NOE with intravenous antibiotics (90%) and blood sugar control (82%). There was less agreement in certain aspects of management including the role of surgery and the nature and duration of follow up.

Conclusions: Our survey provides a picture of NOE management in the UK. While there is consensus in some aspects of NOE management, other aspects attract widely differing answers. This may reflect the lack of strong evidence in the literature. Future work should aim to address this.     

Management of vocal nodules: a regional survey of otolaryngologists and speech-language pathologists

This study surveyed 21 otolaryngologists (70% return) and 32 speech-language pathologists (46% return) in Maine about the treatment of vocal nodules in children and adults, referral patterns, effectiveness of therapy, and adequacy of speech-language pathologists' training. Differences in opinions between the two professional groups were found in treatment of children and referral patterns.     

Internet-based continuing medical education in otolaryngology: a survey of Canadian otolaryngologists

OBJECTIVE: To assess the readiness of the Canadian otolaryngology community for an on-line continuing medical education (CME) program. METHODS: Data were obtained through surveys mailed to members of the Canadian Society of Otolaryngology-Head and Neck Surgery. RESULTS: Two hundred and eight of 321 (65%) surveys were returned. Seventy-six percent of the respondents indicated that they would be interested in participating in an on-line CME course. A greater proportion of younger otolaryngologists and those with community-based practices were interested in participating. A greater number of those with an academic practice were found to have convenient access to the Internet, the ability to post images on-line, and encountered cases they felt worthy of discussion and were willing to instruct/facilitate future on-line CME. Ninety-three percent of respondents described having easy access to the Internet, but only 32% said that they have the equipment necessary to post computed tomographic scans/audiograms on-line. Twenty-three percent had previous computer-based CME experience. Sinusitis and related topics were of greatest interest, with hearing loss/ear surgery and oncology following respectively. CONCLUSIONS: The data suggest that on-line CME would be welcomed and are feasible in the Canadian otolaryngology community.