A New Treatment for Chronic Secretory Otitis Media

Armstrong, B. W.

doi:10.1001/archotol.1954.00710050665001

Cited by 366 publications

(122 citation statements)

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“…3,4 First, as noted earlier, it seems possible that in children who have received tubes, middle ear and/or auditory status may worsen with time. In that regard, it seems worth noting that, as tympanostomy tube insertion in its present form was first introduced in the 1950s, 29 no recipients of tubes during early childhood have as yet reached advanced age. Second, other components of our study have found in children who have received tubes no measurable developmental advantage at either 3 or 4 years of age or, to the extent analyzed, at 6 years of age.…”

Section: Discussionmentioning

confidence: 99%

Tympanic Membrane Abnormalities and Hearing Levels at the Ages of 5 and 6 Years in Relation to Persistent Otitis Media and Tympanostomy Tube Insertion in the First 3 Years of Life: A Prospective Study Incorporating a Randomized Clinical Trial

et al. 2004

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ABSTRACT. Objective. One current practice guideline recommends myringotomy with tympanostomy tube insertion (M&T) for young children in whom middle-ear effusion (MEE) has persisted for 3 months, and another recommends the procedure after MEE has persisted for 4 to 6 months provided that a bilateral hearing loss of >20 dB is present. Sequelae of M&T are not uncommon, but the extent to which these sequelae are attributable to M&T itself or to the middle-ear disease that prompted the procedure or to both has not been clear. Our objective in the present study was to examine the prevalence of various tympanic membrane (TM) abnormalities in otherwise healthy children at the age of 5 years and hearing levels at the age of 6 years in relation to persistent MEE and M&T in the children's first 3 years of life.Methods. In a prospective study of child development in relation to early-life otitis media, we randomly assigned 429 children who met specified criteria regarding the persistence of MEE in their first 3 years of life to undergo M&T either promptly (the "early-treatment" group) or after a defined extended period if MEE remained present (the "late-treatment" group). We also followed a representative sample of 241 children who ranged from having no MEE to having MEE whose cumulative duration fell just short of meeting randomization criteria for the clinical trial (the "nontrial" group). Most of the children in each group underwent both otomicroscopic examination at the age of 5 years and audiometric testing at the age of 6 years, at times when they were free of MEE. Among these children, M&T had been performed in 82.3% of those in the early-treatment group, 38.1% of those in the late-treatment group, and 3.0% of those in the nontrial group.Results. At the age of 5 years, we found 1 or more types of TM abnormality in 1 or both ears in 70.7%, 42.5%, and 9.5% of the children in the early-treatment, late-treatment, and nontrial groups, respectively. Within the 3 groups, however, among children who received tubes, the proportions who had an abnormality of some type were similar, namely, 82.6%, 80.4%, and 83.3%, respectively. The corresponding proportions among children who had not received tubes were 15.4%, 19.3%, and 7.2%, respectively. Segmental atrophy and tympanosclerosis were the most common abnormalities found. At the age of 6 years, mean pure-tone average audiometric thresholds in the early-treatment, late-treatment, and nontrial groups, respectively, were 6.18 dB, 5.49 dB, and 4.63 dB in left ears and 6.17 dB, 6.02 dB, and 4.32 dB in right ears. The thresholds in the early-and late-treatment groups did not differ significantly, but the thresholds in the early-and late-treatment groups were each significantly higher than in the nontrial group. Within the early-and late-treatment groups, we found no significant relation between hearing levels and the presence or type of TM abnormalities.Conclusion. In otherwise healthy children who have persistent MEE during their first 3 years of life, ready resort to M&T results in ...

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Section: Discussionmentioning

confidence: 99%

Tympanic Membrane Abnormalities and Hearing Levels at the Ages of 5 and 6 Years in Relation to Persistent Otitis Media and Tympanostomy Tube Insertion in the First 3 Years of Life: A Prospective Study Incorporating a Randomized Clinical Trial

et al. 2004

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“…The lifetime for the technology was assumed to reflect that the decision would be relevant for 10 years (T). Armstrong 154 first described the use of VTs in 1954, and, since then, use of VTs to restore hearing to normal has been increased. Given the historical longevity of the technology revealed in the literature, it seemed reasonable to assume that use of VTs will last for at least another 10 years before a new technology comes along and replaces it.…”

Section: Value Of Information Analysismentioning

confidence: 99%

The management of Otitis Media with Effusion in children with cleft palate (mOMEnt): a feasibility study and economic evaluation

Bruce

Harman

Williamson

et al. 2015

Health Technol Assess

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BackgroundCleft lip and palate are among the most common congenital malformations, with an incidence of around 1 in 700. Cleft palate (CP) results in impaired Eustachian tube function, and 90% of children with CP have otitis media with effusion (OME) histories. There are several approaches to management, including watchful waiting, the provision of hearing aids (HAs) and the insertion of ventilation tubes (VTs). However, the evidence underpinning these strategies is unclear and there is a need to determine which treatment is the most appropriate.ObjectivesTo identify the optimum study design, increase understanding of the impact of OME, determine the value of future research and develop a core outcome set (COS) for use in future studies.DesignThe management of Otitis Media with Effusion in children with cleft palate (mOMEnt) study had four key components: (i) a survey evaluation of current clinical practice in each cleft centre; (ii) economic modelling and value of information (VOI) analysis to determine if the extent of existing decision uncertainty justifies the cost of further research; (iii) qualitative research to capture patient and parent opinion regarding willingness to participate in a trial and important outcomes; and (iv) the development of a COS for use in future effectiveness trials of OME in children with CP.SettingThe survey was carried out by e-mail with cleft centres. The qualitative research interviews took place in patients’ homes. The COS was developed with health professionals and parents using a web-based Delphi exercise and a consensus meeting.ParticipantsClinicians working in the UK cleft centres, and parents and patients affected by CP and identified through two cleft clinics in the UK, or through the Cleft Lip and Palate Association.ResultsThe clinician survey revealed that care was predominantly delivered via a ‘hub-and-spoke’ model; there was some uncertainty about treatment strategies; it is not current practice to insert VTs at the time of palate repair; centres were in a position to take part in a future study; and the response rate to the survey was not good, representing a potential concern about future co-operation. A COS reflecting the opinions of clinicians and parents was developed, which included nine core outcomes important to both health-care professionals and parents. The qualitative research suggested that a trial would have a 25% recruitment rate, and although hearing was a key outcome, this was likely to be due to its psychosocial consequences. The VOI analysis suggested that the current uncertainty justified the costs of future research.ConclusionsThere exists significant uncertainty regarding the best management strategy for persistent OME in children with clefts, reflecting a lack of high-quality evidence regarding the effectiveness of individual treatments. It is feasible, cost-effective and of significance to clinicians and parents to undertake a trial examining the effectiveness of VTs and HAs for children with CP. However, in view of concerns about recruitment rate and engagement with the clinicians, we recommend that a trial with an internal pilot is considered.FundingThe National Institute for Health Research Health Technology Assessment programme. This study was part-funded by the Healing Foundation supported by the Vocational Training Charitable Trust who funded trial staff including the study co-ordinator, information systems developer, study statistician, administrator and supervisory staff.

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“…Since the reintroduction of ventilation tubes (VT) by Armstrong in 1954, myringotomy with VT insertion has been established as an effective treatment approach for otitis media with effusion (OME) 1 . OME is a middle ear inflammation in which there is retro-tympanic liquid collection, without signs or symptoms of acute infection and integral tympanic membrane 2 .…”

Section: Introductionmentioning

confidence: 99%

Seqüelas de tubos de ventilação em crianças com otite média com efusão: um seguimento de três anos

Pereira¹,

Pereira

Costa

2005

Rev. Bras. Otorrinolaringol.

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Tympanost omy tube (TT) insertion is one of the most frequently performed procedures in otolaryngology. Otorrhea, tympanosclerosis, retraction, perforation, and cholesteatoma are complications reported in the literature after its application. Aim: To determine the incidence and the type of TT insertion sequelae/complications in children presenting with recurrent otitis media and chronic otitis media with effusion undergoing myringotomy and tube placement. Study Design: prospective cohort study. Material and Method: A total of 75 children (150 ears) aged 11 months to 10 years were regularly followed up for up to 38 months after TT insertion. Results: Incidence of sequelae/complications: otorrhea -47.3% of the ears; perforation -2.1%; retractions -39.7%; tympanosclerosis -23.3%. Average length of stay: 12.13 months. Mean age at initial tube placement of children not requiring a second set of tubes = 35.9 months and mean age at initial tube insertion of children requiring an additional set of tubes = 25.6 months (P=0.04). TT stayed longer in the ears that had more episodes of otorrhea (P=0.01). TT insertion with adenoidectomy was associated with a smaller number of otorrhea episodes (P=0.02) Conclusions: Otorrhea was the most frequently found complication. TT placement with adenoidectomy was associated with fewer otorrhea episodes. TT extruded later in those ears that had more episodes of otorrhea. Younger age at the time of the initial tube placement is associated with higher incidence of additional tube placement. One in six patients will probably require a second set of ventilation tubes.

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A New Treatment for Chronic Secretory Otitis Media

Cited by 366 publications

References 0 publications

Tympanic Membrane Abnormalities and Hearing Levels at the Ages of 5 and 6 Years in Relation to Persistent Otitis Media and Tympanostomy Tube Insertion in the First 3 Years of Life: A Prospective Study Incorporating a Randomized Clinical Trial

Tympanic Membrane Abnormalities and Hearing Levels at the Ages of 5 and 6 Years in Relation to Persistent Otitis Media and Tympanostomy Tube Insertion in the First 3 Years of Life: A Prospective Study Incorporating a Randomized Clinical Trial

The management of Otitis Media with Effusion in children with cleft palate (mOMEnt): a feasibility study and economic evaluation

Seqüelas de tubos de ventilação em crianças com otite média com efusão: um seguimento de três anos

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