Grommets in otitis media with effusion: the most frequent operation in children. But is it associated with significant complications?

Vlastarakos, Petros V.; Nikolopoulos, Thomas P.; Korres, Stavros; Tavoulari, Evangelia; Tzagaroulakis, Antonios; Ferekidis, Eleftherios

doi:10.1007/s00431-006-0367-x

Cited by 83 publications

(59 citation statements)

References 74 publications

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“…1,9 The risk of TS especially increases in children who had ventilation tubes inserted. 12,23 The clinical observations indicate that the frequency of myringosclerosis is much higher in tympanic membranes with tympanostomy tube insertion than in tympanic membranes with no tympanostomy tube insertion (23-70% and 0-13%, respectively). 5,11,[23][24][25][26][27][28][29][30] It was also observed that the myringosclerosis rate increased with a larger size of tube, several tube insertions and time of tympanostomy tube stay.…”

Section: Discussionmentioning

confidence: 99%

“…12,23 The clinical observations indicate that the frequency of myringosclerosis is much higher in tympanic membranes with tympanostomy tube insertion than in tympanic membranes with no tympanostomy tube insertion (23-70% and 0-13%, respectively). 5,11,[23][24][25][26][27][28][29][30] It was also observed that the myringosclerosis rate increased with a larger size of tube, several tube insertions and time of tympanostomy tube stay. 25,29,31,32 Based on computer modeling, it has been shown that ventilation tube insertion induces shear stress in the structure of the tympanic membrane.…”

Section: Discussionmentioning

confidence: 99%

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Gene expression profile of collagen types, osteopontin in the tympanic membrane of patients with tympanosclerosis

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Gene expression profile of collagen types, osteopontin in the tympanic membrane of patients with tympanosclerosis

et al. 2017

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“…Cholesteatoma (the abnormal collection of skin cells) formation was not included as a complication of OME because previous investigators among many others suggested that VT insertion can avert sequelae of OME such as cholesteatoma formation. 11,128,130,131 Although there may be a chance of calcium deposition within the eardrum with subsequent increased eardrum rigidity (tympanosclerosis) that could be either due to AOM, 132 OME itself 133 or VT insertion. 134 Therefore no incidence of tympanosclerosis formation was predicted as part of any of the strategies included in this analysis given that the actual cause of tympanosclerosis is not fully understood.…”

Section: Ventilation Tubes Strategymentioning

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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“…childhood and the primary reason for children to visit a physician (Freid et al, 1998;Plasschaert et al, 2006). Furthermore, in many countries, AOM is the most common reason for prescribing antibiotics (Gonzales et al, 2001;Leibovitz, 2003;Pichichero, 2000;Plasschaert et al, 2006) or for undergoing surgery (for the placement of grommets) (Vlastarakos et al, 2007). The most common bacterial species cultured from the nasopharynx of children during otitis media episodes are Streptococcus pneumoniae, Haemophilus influenzae, M. catarrhalis and Staphylococcus aureus, either as single pathogens or as co-cultures (Berner et al, 1996;Pettigrew et al, 2008), with the patterns of nasopharyngeal colonization by micro-organisms being important determinants for otitis media disease (Faden et al, 1991(Faden et al, , 1997Murphy & Parameswaran, 2009).…”

mentioning

confidence: 99%

Colonization of healthy children by Moraxella catarrhalis is characterized by genotype heterogeneity, virulence gene diversity and co-colonization with Haemophilus influenzae

et al. 2011

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The colonization dynamics of Moraxella catarrhalis were studied in a population comprising 1079 healthy children living in Rotterdam, The Netherlands (the Generation R Focus cohort). A total of 2751 nasal swabs were obtained during four clinic visits timed to take place at 1.5, 6, 14 and 24 months of age, yielding a total of 709 M. catarrhalis and 621 Haemophilus influenzae isolates. Between January 2004 and December 2006, approximate but regular 6-monthly cycles of colonization were observed, with peak colonization incidences occurring in the autumn/winter for M. catarrhalis, and winter/spring for H. influenzae. Co-colonization was significantly more likely than single-species colonization with either M. catarrhalis or H. influenzae, with genotypic analysis revealing no clonality for co-colonizing or single colonizers of either bacterial species. This finding is especially relevant considering the recent discovery of the importance of H. influenzae-M. catarrhalis quorum sensing in biofilm formation and host clearance. Bacterial genotype heterogeneity was maintained over the 3-year period of the study, even within this relatively localized geographical region, and there was no association of genotypes with either season or year of isolation. Furthermore, chronological and genotypic diversity in three immunologically important M. catarrhalis virulence genes (uspA1, uspA2 and hag/mid ) was also observed. This study indicates that genotypic variation is a key factor contributing to the success of M. catarrhalis colonization of healthy children in the first years of life. Furthermore, variation in immunologically relevant virulence genes within colonizing populations, and even within genotypically identical M. catarrhalis isolates, may be a result of immune evasion by this pathogen. Finally, the factors facilitating M. catarrhalis and H. influenzae co-colonization need to be further investigated. INTRODUCTIONMoraxella catarrhalis is part of the normal bacterial flora in the nasopharynx of children, although over the past two decades, it has emerged as a significant bacterial pathogen and not simply a commensal colonizer (Verduin et al., 2002). Studies have shown that the bacterium rapidly colonizes the nasopharynx soon after birth and that the carriage rate of M. catarrhalis in healthy children varies between 7 and 36 % (Verhaegh et al., 2010). However, in children with upper respiratory tract infections (URTI), including acute otitis media (AOM), the carriage rate increases to approximately 50 % (Berner et al., 1996;Konno et al., 2006;Pettigrew et al., 2008). Otitis media itself is a particularly important URTI during early Abbreviations: AOM, acute otitis media; CEACAM, carcinoembryonic antigen-related cell adhesion molecule; LOS, lipooligosaccharide; MLST, multilocus sequence typing; OMP, outer-membrane protein; OR, odds ratio; OMV, outer-membrane vesicle; URTI, upper respiratory tract infection. childhood and the primary reason for children to visit a physician (Freid et al., 1998;Plasschaert et al., 2006). Furt...

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Grommets in otitis media with effusion: the most frequent operation in children. But is it associated with significant complications?

Cited by 83 publications

References 74 publications

Gene expression profile of collagen types, osteopontin in the tympanic membrane of patients with tympanosclerosis

Gene expression profile of collagen types, osteopontin in the tympanic membrane of patients with tympanosclerosis

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

Colonization of healthy children by Moraxella catarrhalis is characterized by genotype heterogeneity, virulence gene diversity and co-colonization with Haemophilus influenzae

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