Objective In children with ventilation tubes (VTs) inserted for chronic otitis media with effusion (COME), determine if any parameter of Eustachian tube (ET) function measured by the Forced Response Test (FRT) predicts disease recurrence after the VT becomes non-functional. Study Design Prospective study of those factors that predict disease recurrence in children with VTs inserted for COME. Methods Forty-nine subjects (73 ears; 28 male, 34 white, aged 5.3±1.2 years) with COME had VTs inserted and were evaluable for disease status after the VT(s) became non-functional. The FRT was done when the VTs were patent and results for the last test before the VT became non-functional were used in the analysis. After each VT became non-functional, the children were followed for disease recurrence over a 12-month period. Logistic regression was used to determine if the ET opening pressure, closing pressure and/or Dilatory Efficiency predicted disease recurrence. That model was expanded to include age, sex, race, history of adenoidectomy, previous VTs and the duration of VT patency as potential predictive factors. Results Twenty-nine (40%) ears had recurrence of significant disease within 12 months after the VT became non-functional. For the complete logistic regression model, male gender (P=0.03), non-white race (P=0.02), a shorter period of VT patency (P=0.01) and a low Dilatory Efficiency (P=0.01) were significant predictors of disease recurrence. Conclusion A measure of active ET function, Dilatory Efficiency, but not measures of passive function predicted disease recurrence within the 12 months after the VT became non-functional in children with COME.
Objective Report the results for an interim analysis of the data collected to date for an ongoing study designed to characterize the age-related changes in Eustachian tube opening efficiency measured using a pressure chamber protocol in children without a history of middle ear disease. Methods To date, 41, 3-year old children without past otitis media were enrolled in a longitudinal study of the changes in Eustachian tube function between 3 and 7 years of age. At entry and at scheduled 1-year intervals, Eustachian tube opening efficiency, quantified by the percent of the applied pressure gradient between the middle ear and chamber that was equilibrated by a swallow, was measured using a pressure chamber protocol. For this analysis, the data for 120 tests with representation across all ages were treated as independent observations and analyzed using an ANOVA with variance partitioned for effects of age (3 through 6 years), gradient direction (positive/negative) and ear (left/right). Results Eustachian tube opening efficiency was higher for left versus right ears and for positive versus negative driving gradients, but was not different among age groups. Conclusions Limitations of the pressure chamber protocol were identified and accounted for in the analysis. The measure of Eustachian tube opening efficiency used in this test protocol behaved similarly to other, more standard measures in response to driving gradient direction. A finer resolution of possible age-related differences in Eustachian tube opening efficiency is expected on application of more sophisticated statistical models to the complete dataset at study end.
Objective Test the hypothesis that Eustachian tube opening efficiency measured as the fractional gradient equilibrated (FGE) is lower in 6-year-old children with no middle-ear disease but a well-documented history of recurrent acute otitis media when compared to children with a negative disease history (Control). Study Design Cross-sectional study Setting Tertiary-care pediatric hospital Subjects and Methods Bilateral Eustachian tube function was evaluated in 44 healthy 6-year-old children (19 male, 29 white). None had middle-ear disease at the time of testing, but 23 had a history of recurrent acute otitis media. Twenty-one had no significant past otitis media. Eustachian tube function was measured using a pressure-chamber protocol that established negative middle-ear gauge pressures (referenced to the chamber pressure) and recorded that pressure before and after a swallow. FGE was calculated as the change in middle-ear gauge pressure with swallowing divided by the pre-swallow pressure. Between-group comparisons of the pre-swallow pressures and FGEs were made using a 2-tailed Student’s t test. Results FGE was independent of the pre-swallow middle-ear gauge pressure. For the 39 and 44 evaluable ears in the control and recurrent acute otitis media groups, the mean pre-swallow pressures were −194 (95%CI=−211 to −177) versus −203 (95%CI=−216 to −190) daPa (P>0.40) and FGEs were 0.32 (95%CI=0.21 to 0.43) vs 0.16 (95%CI=0.08 to 0.24) (P=0.016), respectively. Conclusion In children with past recurrent acute otitis media, residual Eustachian tube opening inefficiency is maintained after the child has “outgrown” their middle-ear disease.
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