Perioperative Hearing Evaluations for Patients Undergoing Tympanostomy Tube Placement

Whittemore, Kenneth R.; Dornan, Briana K.; Dargie, Jenna M.; Zhou, Guangwei

doi:10.1001/jamaoto.2016.1980

Cited by 3 publications

(4 citation statements)

References 6 publications

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“…Without preoperative hearing testing, necessity of surgery may be unclear, and hearing improvement after surgery cannot be ascertained 92 . Postoperative hearing loss was found in 14% of children receiving tympanostomy tubes 93 and in 23% of children with preoperative hearing loss 91 . However, if the decision to undergo tube placement has been made on the basis of risk criteria or subjective hearing difficulties and only a single hearing test can be obtained, a postoperative hearing test may be the best use of resources in such cases to determine if postoperative hearing function is normal and if further treatment is needed 93 …”

Section: Guideline Key Action Statementsmentioning

confidence: 99%

“…Clinicians should ideally assess a child’s hearing before surgery and at the first postoperative visit, but when resources or access to audiometry is limited, a single postoperative assessment may be the best approach to document normal hearing. In a single‐institution case series 91 of nearly 2300 children, 80% had hearing loss before tube insertion, with hearing improvement noted in most, but not all, children after surgery. 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.…”

Section: Guideline Key Action Statementsmentioning

confidence: 99%

“…Although hearing loss due to OME is often cited as a cause of adverse speech, language, and behavioral development, evidence for such a link in otherwise healthy children is lacking, 90 and the benefit of tube surgery is unknown in children with speech-language delays. 22 Since benefit is predicated on improving hearing, postoperative hearing evaluation should be completed after tympanostomy tube placement to determine resolution of a preoperative hearing loss but may not be necessary following normal preoperative test results 91 (KAS 4). Failure to obtain audiometry preoperatively is common despite national guidelines predicating the need for surgery based on hearing levels.…”

Section: S12mentioning

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 Statementsmentioning

confidence: 99%

Section: Guideline Key Action Statementsmentioning

confidence: 99%

Section: S12mentioning

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

“…8 Hong, Kim e Chung (2014) 16 , ao analisarem a audição em longo prazo por meio da audiometria tonal em pacientes com otite média secretora que realizaram operação de colocação de tubo de ventilação, concluíram que houve melhora, porém tiveram dificuldades em avaliar objetivamente, pois, em muitos casos, também não houve retorno para a realização do exame. Whittermore et al (2016) 23 encontraram em 1.395 pacientes (61,3%), de um total de 2.274, que realizaram avaliação audiométrica pré e pós-operatória, sendo que aproximadamente 80% tinham algum grau de perda de audição pré-operatória, e 74,3% alcançaram audição normal após a operação.…”

Section: Discussionunclassified

Perfil clínico e audiológico de pacientes submetidos a timpanostomia e inserção de tubo de ventilação.

Polanski¹,

Lopes

Arimori

et al. 2022

BioSCIENCE

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Introdução: A presença de líquido na orelha média, uma consequência comum das otites, pode causar perdas auditivas de condução e, consequentemente, atrasos no desenvolvimento da criança. A timpanotomia e colocação do tubo de ventilação é o tratamento para casos em que o acúmulo de secreção é persistente. Objetivo: Avaliar o perfil epidemiológico (sexo, idade, diagnóstico, tipo de intervenção, comorbidades, queixas clínicas) e audiológico dos pacientes submetidos a timpanotomia e colocação do tubo de ventilação entre janeiro de 2018 e janeiro de 2020. Métodos: é um estudo observacional, retrospectivo e transversal baseado em revisão de prontuários. Resultados: Foram incluídos 69 pacientes que realizaram a cirurgia. O sexo masculino correspondeu a 44 paciente (64%) e a média de idade dos pacientes foi de 8 anos. Otite média secretora foi o diagnóstico predominante. Pelo menos uma comorbidade foi encontrada em 63 pacientes, com predomínio de rinite alérgica. A maioria dos pacientes realizaram apenas 1 cirurgia. A bilateralidade da colocação do tubo ocorreu em 39 pacientes (57%). Amigdalectomia e/ou adenoidectomia foram frequentemente realizadas no momento da timpanotomia com colocação de tubo. Hipoacusia, roncopatia, prurido nasal, obstrução nasal e respiração oral noturna foram as queixas predominantes. Em relação à audiometria, 68% dos pacientes evoluíram para limiares normais; já na timpanometria 62% evoluíram para melhora da curva no timpanograma. Conclusão: Os achados clínicos mais presentes na nossa amostra foram: sexo masculino, pacientes pediátricos, com presença de rinite alérgica como comorbidade, queixa clínica de perda auditiva e tratamento com colocação de tubo de ventilação bilateral. Houve melhora pós-operatória na audiometria e timpanometria na maioria dos casos.

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Management of conductive hearing loss from otitis media in children operative techniques in otolaryngology

Bloom,

Brodsky

2024

Operative Techniques in Otolaryngology-Head and Neck Surgery

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Perioperative Hearing Evaluations for Patients Undergoing Tympanostomy Tube Placement

Abstract: A postoperative audiometric examination should be performed in children who have hearing loss when evaluated before TT placement to determine whether resolution of the hearing loss was obtained.

Cited by 3 publications

References 6 publications

Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)

Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)

Perfil clínico e audiológico de pacientes submetidos a timpanostomia e inserção de tubo de ventilação.

Management of conductive hearing loss from otitis media in children operative techniques in otolaryngology

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