Follow-up audiometry after bilateral myringotomy and tympanostomy tube insertion

Hu, Shirley; Patel, Neha A.; Shinhar, Shai

doi:10.1016/j.ijporl.2015.09.015

Cited by 7 publications

(7 citation statements)

References 9 publications

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“…Postoperative audiometry revealed a 3.9% prevalence of sensorineural hearing loss and a 0.6% prevalence of persistent conductive hearing loss, despite resolution of MEE. This finding has been corroborated by other case series, 277 demonstrating improved hearing in most children after tympanostomy tube placement but with a small percentage having persistent hearing loss. These studies support obtaining a postoperative hearing evaluation after tympanostomy tube placement to document hearing status.…”

Section: Guideline Key Action Statementssupporting

confidence: 81%

“…This finding has been corroborated by other case series, 277 demonstrating improved hearing in most children after tympanostomy tube placement but with a small percentage having persistent hearing loss. These studies support obtaining a postoperative hearing evaluation after tympanostomy tube placement to document hearing status.…”

Section: Action Statement Profilesupporting

confidence: 81%

“…These studies support obtaining a postoperative hearing evaluation after tympanostomy tube placement to document hearing status. This evaluation should be performed at least 6 weeks after tube placement, as progressive hearing improvement can be expected over the first postoperative month in most patients (as middle ear edema and inflammation subside), and earlier audiometry may underestimate the degree of hearing improvement 277 …”

Section: Guideline Key Action Statementsmentioning

confidence: 99%

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Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)

Rosenfeld

Tunkel

Schwartz

et al. 2022

Otolaryngol.--head neck surg.

164

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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. All these conditions are encompassed by the term otitis media (middle ear inflammation). This guideline update provides evidence-based recommendations for patient selection and surgical indications for managing tympanostomy tubes in children. The guideline is intended for any clinician involved in managing children aged 6 months to 12 years with tympanostomy tubes or children being considered for tympanostomy tubes in any care setting as an intervention for otitis media of any type. The target audience includes specialists, primary care clinicians, and allied health professionals. Purpose The purpose of this clinical practice guideline update is to reassess and update recommendations in the prior guideline from 2013 and to provide clinicians with trustworthy, evidence-based recommendations on patient selection and surgical indications for managing tympanostomy tubes in children. In planning the content of the updated guideline, the guideline update group (GUG) affirmed and included all the original key action statements (KASs), based on external review and GUG assessment of the original recommendations. The guideline update was supplemented with new research evidence and expanded profiles that addressed quality improvement and implementation issues. The group also discussed and prioritized the need for new recommendations based on gaps in the initial guideline or new evidence that would warrant and support KASs. The GUG further sought to bring greater coherence to the guideline recommendations by displaying relationships in a new flowchart to facilitate clinical decision making. Last, knowledge gaps were identified to guide future research. Methods In developing this update, the methods outlined in the American Academy of Otolaryngology–Head and Neck Surgery Foundation’s “Clinical Practice Guideline Development Manual, Third Edition: A Quality-Driven Approach for Translating Evidence Into Action” were followed explicitly. The GUG was convened with representation from the disciplines of otolaryngology–head and neck surgery, otology, pediatrics, audiology, anesthesiology, family medicine, advanced practice nursing, speech-language pathology, and consumer advocacy. Action Statements The GUG made strong recommendations for the following KASs: (14) clinicians should prescribe topical antibiotic ear drops only, without oral antibiotics, for children with uncomplicated acute tympanostomy tube otorrhea; (16) the surgeon or designee should examine the ears of a child within 3 months of tympanostomy tube insertion AND should educate families regarding the need for routine, periodic follow-up to examine the ears until the tubes extrude. The GUG made recommendations for the following KASs: (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, from the date of onset (if known) or from the date of diagnosis (if onset is unknown); (2) clinicians should obtain a hearing evaluation if OME persists for 3 months or longer 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 AND documented hearing difficulties; (5) clinicians should reevaluate, at 3- to 6-month intervals, children with chronic OME who do 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; (6) clinicians should not perform tympanostomy tube insertion in children with recurrent acute otitis media who do not have middle ear effusion in either ear at the time of assessment for tube candidacy; (7) clinicians should offer bilateral tympanostomy tube insertion in children with recurrent acute otitis media who have unilateral or bilateral middle ear effusion at the time of assessment for tube candidacy; (8) clinicians should determine if a child with recurrent acute otitis media or with OME of any duration is at increased risk for speech, language, or learning problems from otitis media because of baseline sensory, physical, cognitive, or behavioral factors; (10) the clinician should not place long-term tubes as initial surgery for children who meet criteria for tube insertion unless there is a specific reason based on an anticipated need for prolonged middle ear ventilation beyond that of a short-term tube; (12) in the perioperative period, clinicians should educate caregivers of children with tympanostomy tubes regarding the expected duration of tube function, recommended follow-up schedule, and detection of complications; (13) clinicians should not routinely prescribe postoperative antibiotic ear drops after tympanostomy tube placement; (15) clinicians should not encourage routine, prophylactic water precautions (use of earplugs or headbands, avoidance of swimming or water sports) for children with tympanostomy tubes. The GUG offered the following KASs as options: (4) clinicians may perform tympanostomy tube insertion in children with unilateral or bilateral OME for 3 months or longer (chronic OME) AND symptoms that are likely attributable, all or in part, to OME that include, but are not limited to, balance (vestibular) problems, poor school performance, behavioral problems, ear discomfort, or reduced quality of life; (9) clinicians may perform tympanostomy tube insertion in at-risk children with unilateral or bilateral OME that is likely to persist as reflected by a type B (flat) tympanogram or a documented effusion for 3 months or longer; (11) clinicians may perform adenoidectomy as an adjunct to tympanostomy tube insertion for children with symptoms directly related to the adenoids (adenoid infection or nasal obstruction) OR in children aged 4 years or older to potentially reduce future incidence of recurrent otitis media or the need for repeat tube insertion.

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Section: Guideline Key Action Statementssupporting

confidence: 81%

Section: Action Statement Profilesupporting

confidence: 81%

Section: Guideline Key Action Statementsmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)

Rosenfeld

Tunkel

Schwartz

et al. 2022

Otolaryngol.--head neck surg.

164

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show abstract

“…13,14 Chow et al evaluated the quality of life using OM-6 survey which measures quality of life by using some of the above mentioned parameters including physical suffering, hearing loss, speech impairment, emotional distress, activity limitations and caregiver concerns. 8,12 The presenting complaints in our study included aural fullness in 32 patients, ear pain in 39 patients, impaired hearing in 38 patients, tinnitus in 14 patients, nasal block in 23 patients and running nose in 27 patients. This corresponded to aural fullness in 64%, ear pain 78%, impaired hearing in 76%, tinnitus in 28%, associated nasal block in 46% and running nose in 54% of the study subjects.…”

Section: Resultsmentioning

confidence: 97%

Clinical study and post operative outcomes of tympanostomy tube insertion in otitis media with effusion

Kumar

Mahajan

Thomas

et al. 2020

Int J Otorhinolaryngol Head Neck Surg

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Background: Otitis media with effusion (OME) is defined as the presence of a middle ear effusion in the absence of infection. Fluid in the middle ear is associated most commonly with a conductive hearing loss and an increased risk of acute middle ear infection. It can have an impact on quality of life. The objective of our study was to assess symptomatology of OME, study complications following tympanostomy tube insertion in OME and to highlight the age, sex distribution of otitis media with effusion.Methods: This prospective study was conducted in Department of Otorhinolaryngology, Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune from October 2017 to March 2019. 50 ears of patients aged between 6 to 50 years with OME were included in the study. All the patients were observed for symptomatology and postoperative complications who underwent Tympanostomy tube insertion. Results: OME is commoner in children and adolescents with no gender preponderance. The most common otoscopic findings pre-operatively included dull lustreless amber colored tympanic membrane in 56% (n=28), Retracted Tympanic Membrane and for shortened handle of malleus in 28% (n=14), air bubbles were seen in 12% (n=6) whereas fluid level was seen in 4% (n=2). Common complications post operatively included myringosclerosis and tympanic membrane atelectasis seen in 10% and 6% respectively.Conclusions: Tympanostomy tube insertion is one of the ideal treatments in management of otitis media with effusion, most commonly affecting younger age groups, with fewer complications, which can lead to a better quality of life.

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“…Щодо лікування ексудативного отиту (ЕО) у дітей досі немає єдиної лікувальної схеми, котра задовольняла би отоларингологів за своєю ефективністю [5]. Існує декілька лікувальних тактик при веденні дитини з ЕО і АВ: призначення топічних стероїдів для ліквідації запального процесу в глотковому мигдалику і відновлення вентиляційної функції слухових труб [3], відкриття отворів слухових труб шляхом видалення АВ [4], виконання тимпанотомії чи тимпаностомії для евакуації вмісту барабанної порожнини і відновлення прохідності слухових труб [2]. При цьому в кожному конкретному випадку лікар приймає рішення щодо доцільності виконання інвазійних хірургічних втручань або ж надання переваги консервативному лікуванню, котре може виявитися недостатньо ефективним.…”

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Тимпанотомія І Аденотомія Versus Аденотомія При Лікуванні Ексудативного Отиту У Дітей

Левицька¹,

Солдат²,

Яковець³

et al. 2016

Buk. Med. Herald

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We determined the effectiveness of tympanotomy and of the therapy by topical steroids in addition to the surgical removal of the adenoid vegetations in 48 children with adenoid vegetations of the II-III degree and exudative otitis. Evaluation of the results of treatment ten days after the surgery showed that the simultaneous tympanotomy and adenotomy promoted the more rapid recovery of the functions of the middle ear as compared to adenotomy, while receiving topical steroids had no effect on recovery of auditory tube function. One month after the surgery, development of hearing loss was observed in 35,4 % of children and accumulation of fluid in the tympanum-in 12,5 %. In children whose treatment was limited to adenotomy, the frequency of detection of fluid in the middle ear was 25 %. Evaluation of the recovery of auditory function a month after the surgery showed similar efficacy of the local use of topical steroids and tympanotomy. Performing adenotomy alone was not sufficient to fully restore the hearing function.

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Follow-up audiometry after bilateral myringotomy and tympanostomy tube insertion

Cited by 7 publications

References 9 publications

Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)

Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)

Clinical study and post operative outcomes of tympanostomy tube insertion in otitis media with effusion

Тимпанотомія І Аденотомія Versus Аденотомія При Лікуванні Ексудативного Отиту У Дітей

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