Tympanic membrane atrophy, scarring, atelectasis and attic retraction in persistent, untreated otitis media with effusion and following ventilation tube insertion

Maw, A. R.; Bawden, R

doi:10.1016/0165-5876(94)90060-4

Cited by 66 publications

(76 citation statements)

References 6 publications

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“…In 1 of the studies, the prevalence in unoperated ears was 7.5%, a value high enough to suggest to the authors that the scarring had been caused by the underlying disease. 20 Findings in the present study are consistent with that observation. We found higher rates of TM abnormalities among children in the early-and late-treatment groups who had not undergone M&T (15.4% and 19.3%, respectively) than among children in the nontrial group who had not undergone M&T (7.2%; P ϭ .011), and we found that, in children in the nontrial group who had not undergone M&T, abnormalities were essentially limited to children who had had substantial periods of MEE.…”

Section: Tm Abnormalitiessupporting

confidence: 83%

“…Indeed, we found higher rates of TM abnormalities in the children whose only or initial M&T was performed before 24 months of age than in those in whom the procedure was performed at older ages. In contrast, tympanosclerosis in the present study was found in 40.4% of the ears of children who had received tubes, a value relatively close to the prevalence of 31.7% reported by Kay et al 7 Fibrosis of the TM as described in the present study was probably the equivalent of the finding described by earlier authors as thickening or minor scarring, [18][19][20] a condition considered to constitute an intermediate stage in the development of tympanosclerosis. 19 In 2 previous studies of children with persistent MEE, the prevalence of thickening or minor scarring (as differentiated from tympanosclerosis) in ears that had received tubes was 12.7% 18 and 14%, 20 respectively.…”

Section: Tm Abnormalitiescontrasting

confidence: 56%

“…Notably, previous studies included no comparison group of children with indifferent or no histories of otitis media, 6,[15][16][17][18][19][20][21][22][23][24][25] or they considered consequences of M&T that had been performed after the first 3 years of life or at unspecified ages, 6,7,[15][16][17][18][19][20][21][22][23]26 or they had smaller sample sizes, 6,15,16,18,[20][21][22][23][24]26 or they used retrospective or nonrandom designs, 6,17,19,23,26 or all or many of the subjects had undergone associated adenoidectomy and/or tonsillectomy, 6,15,[18][19][20][21]23,24 or methods of treatment for episodes of otitis media were not specified, ...…”

Section: Design Issuesmentioning

confidence: 99%

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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: Tm Abnormalitiessupporting

confidence: 83%

Section: Tm Abnormalitiescontrasting

confidence: 56%

Section: Design Issuesmentioning

confidence: 99%

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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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“…28,30,33,36,37,46,54,64,65 Otorrhea and tympanosclerosis occurred more frequently in ears with tube placement than in ears with watchful waiting or myringotomy (low SOE). Evidence was insufficient for other harms because of either conflicting results or data reported in only a single study.…”

Section: Tympanostomy Tubes Versus Watchful Waiting or Myringotomymentioning

confidence: 99%

Surgical Treatments for Otitis Media With Effusion: A Systematic Review

et al. 2014

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BACKGROUND AND OBJECTIVE: The near universality of otitis media with effusion (OME) in children makes a comparative review of treatment modalities important. This study' s objective was to compare the effectiveness of surgical strategies currently used for managing OME. METHODS:We identified 3 recent systematic reviews and searched 4 major electronic databases. Eligible studies included randomized controlled trials, nonrandomized trials, and cohort studies that compared myringotomy, adenoidectomy, tympanostomy tubes (tubes), and watchful waiting. Using established criteria, pairs of reviewers independently selected, extracted data, rated risk of bias, and graded strength of evidence of relevant studies. We incorporated meta-analyses from the earlier reviews and synthesized additional evidence qualitatively. RESULTS:We identified 41 unique studies through the earlier reviews and our independent searches. In comparison with watchful waiting or myringotomy (or both), tubes decreased time with OME and improved hearing; no specific tube type was superior. Adenoidectomy alone, as an adjunct to myringotomy, or combined with tubes, reduced OME and improved hearing in comparison with either myringotomy or watchful waiting. Tubes and watchful waiting did not differ in language, cognitive, or academic outcomes. Otorrhea and tympanosclerosis were more common in ears with tubes. Adenoidectomy increased the risk of postsurgical hemorrhage.CONCLUSIONS: Tubes and adenoidectomy reduce time with OME and improve hearing in the short-term. Both treatments have associated harms. Large, well-controlled studies could help resolve the riskbenefit ratio by measuring acute otitis media recurrence, functional outcomes, quality of life, and long-term outcomes. Research is needed to support treatment decisions in subpopulations, particularly in patients with comorbidities.

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“…Tympanostomy tubes lead to further atrophy of the TM and focal atelectatic areas. 16 Placement of a tube in an already atelectatic ear can result in further deterioration of existing disease. 7 Furthermore, multiple tympanostomy tubes increase the risk of TM atelectasis.…”

Section: Conmentioning

confidence: 99%

Does Early Surgical Intervention of Middle Ear Atelectasis Improve Long-term Results and Prevent Cholesteatoma?

Saunders¹

2008

Arch Otolaryngol Head Neck Surg

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Tympanic membrane atrophy, scarring, atelectasis and attic retraction in persistent, untreated otitis media with effusion and following ventilation tube insertion

Cited by 66 publications

References 6 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

Surgical Treatments for Otitis Media With Effusion: A Systematic Review

Does Early Surgical Intervention of Middle Ear Atelectasis Improve Long-term Results and Prevent Cholesteatoma?

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