Epidemiology of Secretory Otitis Media a Descriptive Cohort Study

Fiellau-Nikolajsen, M

doi:10.1177/000348948309200215

Cited by 54 publications

(31 citation statements)

References 13 publications

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“…A normal type A tympanogram ( Figure 5), with peak pressure greater than -100 mm water, is associated with effusion in only 3% of ears at myringotomy. 107,108 Proper calibration of the tympanometer is essential for accurate results.…”

Section: Supporting Textmentioning

confidence: 99%

Clinical Practice Guideline: Tympanostomy Tubes in Children

Rosenfeld

Schwartz

Pynnonen

et al. 2013

Otolaryngol.--head neck surg.

340

134

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Objective. Insertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the United States. Tympanostomy tubes are most often inserted because of persistent middle ear fluid, frequent ear infections, or ear infections that persist after antibiotic therapy. Despite the frequency of tympanostomy tube insertion, there are currently no clinical practice guidelines in the United States that address specific indications for surgery. This guideline is intended for any clinician involved in managing children, aged 6 months to 12 years, with tympanostomy tubes or being considered for tympanostomy tubes in any care setting, as an intervention for otitis media of any type.Purpose. The primary purpose of this clinical practice guideline is to provide clinicians with evidence-based recommendations on patient selection and surgical indications for and management of tympanostomy tubes in children. The development group broadly discussed indications for tube placement, perioperative management, care of children with indwelling tubes, and outcomes of tympanostomy tube surgery. Given the lack of current published guidance on surgical indications, the group focused on situations in which tube insertion would be optional, recommended, or not recommended. Additional emphasis was placed on opportunities for quality improvement, particularly regarding shared decision making and care of children with existing tubes.Action Statements. The development group made a strong recommendation that clinicians should prescribe topical antibiotic eardrops only, without oral antibiotics, for children with uncomplicated acute tympanostomy tube otorrhea. The panel made recommendations that (1) clinicians should not perform tympanostomy tube insertion in children with a single episode of otitis media with effusion (OME) of less than 3 months' duration; (2) clinicians should obtain an age-appropriate hearing test if OME persists for 3 months or longer (chronic OME) or prior to surgery when a child becomes a candidate for tympanostomy tube insertion; (3) clinicians should offer bilateral tympanostomy tube insertion to children with bilateral OME for 3 months or longer (chronic OME) and documented hearing difficulties; (4) clinicians should reevaluate, at 3-to 6-month intervals, children with chronic OME who did not receive tympanostomy tubes until the effusion is no longer present, significant hearing loss is detected, or structural abnormalities of the tympanic membrane or middle ear are suspected; (5) clinicians should not perform tympanostomy tube insertion in children with recurrent acute otitis media (AOM) who do not have middle ear effusion in either ear at the time of assessment for tube candidacy; (6) clinicians should offer bilateral tympanostomy tube insertion to children with recurrent AOM who have unilateral or bilateral middle ear effusion at the time of assessment for tube candidacy; (7) clinicians should determine if a child with recurrent AOM or with OME of any duration is at increased risk for sp...

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Section: Supporting Textmentioning

confidence: 99%

Clinical Practice Guideline: Tympanostomy Tubes in Children

Rosenfeld

Schwartz

Pynnonen

et al. 2013

Otolaryngol.--head neck surg.

340

134

View full text Add to dashboard Cite

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“…32,33 Children were excluded if they had current clinical features of acute otitis media (e.g., ear pain, fever or otoscopic features of acute inflammation), recent or planned ear surgery, a known latex allergy or a recent nosebleed.…”

Section: Eligibility Criteriamentioning

confidence: 99%

Effect of nasal balloon autoinflation in children with otitis media with effusion in primary care: an open randomized controlled trial

Williamson

Vennik

Harnden

et al. 2015

CMAJ

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“…At least one ear with a type B tympanogram (using the modified Jerger classification). [69][70][71] PLUS 3. (a) For children (aged 4-6 years) identified from the practice age/sex register, parental concern with report of at least one relevant symptom/concern associated with OME in the previous 3 months from the following symptom/concern checklist: The randomisation method used an algorithm with minimisation based on three previously found key variables: age, sex and baseline severity of OME.…”

Section: Inclusion Criteriamentioning

confidence: 99%

An open randomised study of autoinflation in 4- to 11-year-old school children with otitis media with effusion in primary care

Williamson

Vennik

Harnden

et al. 2015

Health Technol Assess

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BackgroundOtitis media with effusion (OME) is a very common problem in primary care, but one that lacks an evidence-based non-surgical treatment.ObjectiveTo determine the clinical effectiveness of nasal balloon autoinflation for the treatment of OME in children.DesignA pragmatic, two-arm, open randomised controlled trial.SettingForty-three general practices from 17 UK primary care trusts recruited between January 2012 and February 2013.ParticipantsSchool children aged 4–11 years with a history of OME symptoms or related concerns in the previous 3 months, and a type B tympanogram, diagnostic of a middle ear effusion, in one or both ears.InterventionThree hundred and twenty children were randomised, 160 to each group, using independent web-based computer-generated randomisation (with minimisation based on age, sex and baseline severity of OME) to either nasal balloon autoinflation performed three times per day for 1–3 months plus usual care, or usual care alone.Main outcome measuresThe proportion of children demonstrating clearance of middle ear fluid in at least one ear (with normal tympanograms) at 1 and 3 months, assessed blind to treatment. An ear-related measure of quality of life (QoL) [a 14-point questionnaire on the impact of OME (OMQ-14)], weekly diary recorded symptoms, compliance and adverse events were all secondary outcomes.ResultsAt 1 month, the proportion of children with normal tympanograms was 47.3% (62/131) in those allocated to autoinflation and 35.6% (47/132) in those receiving usual care [adjusted relative risk (RR) 1.36, 95% confidence interval (CI) 0.99 to 1.88]. At 3 months, the proportions were 49.6% (62/125) and 38.3% (46/120), respectively (adjusted RR 1.37, 95% CI 1.03 to 1.83; number needed to treat = 9). The change in OMQ-14 also favoured the intervention arm (adjusted global score difference –0.42;p = 0.001). Reported compliance was good: 89% in the first month and 80% in months 2 and 3. Adverse events included otalgia in 4% of treated children compared with 1% in the control group. Minor nosebleeds (14% vs. 15%) and respiratory tract infections (18% vs. 13%) were noted.ConclusionWe found the use of autoinflation in young children with OME to be feasible in primary care and effective in both clearing effusions and improving child and parent ear-related QoL and symptoms. This method has scope to be used more widely. Further research is needed for very young children, and to inform prudent use in different health settings.Trial registrationCurrent Controlled Trials ISRCTN55208702.FundingThis project was funded by the National institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment, Vol. 19, No. 72. See the NIHR Journals Library website for further project information.

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Epidemiology of Secretory Otitis Media a Descriptive Cohort Study

Cited by 54 publications

References 13 publications

Clinical Practice Guideline: Tympanostomy Tubes in Children

Clinical Practice Guideline: Tympanostomy Tubes in Children

Effect of nasal balloon autoinflation in children with otitis media with effusion in primary care: an open randomized controlled trial

An open randomised study of autoinflation in 4- to 11-year-old school children with otitis media with effusion in primary care

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