Perfil clínico e audiológico de pacientes submetidos a timpanostomia e inserção de tubo de ventilação / Clinical and audiological features in patients undergoing tympanostomy tube placement

Introdução: A presença de líquido na orelha médiapode causar perdas auditivas de condução e 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 e audiológico dos pacientes submetidos a timpanotomia e colocação do tubo de ventilação. Métodos: Estudo observacional, retrospectivo e transversal baseado em revisão de prontuários. Resultados: Foram incluídos 69 pacientes que realizaram o procedimento. O sexo masculino correspondeu a 64% e a média de idade 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 realizou apenas 1 operação. A bilateralidade da colocação do tubo ocorreu em 57%. Amigdalectomia e/ou adenoidectomia foram frequentemente adicionadas. Hipoacusia, roncopatia, prurido nasal, obstrução nasal e respiração oral noturna foram as queixas predominantes. Em relação à audiometria, 68% evoluíram para limiares normais; já na timpanometria 62% mostraram melhora no timpanograma. Conclusão: No tratamento com colocação de tubo de ventilação bilateral houve melhora pós-operatória na audiometria e timpanometria na maioria dos casos.

Introduction: The presence of fluid in the middle ear can cause conductive hearing loss and developmental delays in children. Tympanotomy and ventilation tube placement is the treatment for cases where secretion accumulation is persistent. Objective: To evaluate the epidemiological and audiological profile of patients submitted to tympanotomy and ventilation tube placement. Methods: Observational, retrospective and cross-sectional study based on medical records. Results: 69 patients who underwent the procedure were included. Males accounted for 64% and the mean age was 8 years. Secretory otitis media was the predominant diagnosis. At least one comorbidity was found in 63 patients, with a predominance of allergic rhinitis. Most performed only 1 operation. Bilateral tube placement occurred in 57%. Tonsillectomy and/or adenoidectomy were frequently added. Hypoacusis, snoring, nasal itching, nasal obstruction and nocturnal oral breathing were the predominant complaints. Regarding audiometry, 68% evolved to normal thresholds; in the tympanometry 62% showed improvement in the tympanogram. Conclusion: In the treatment with placement of a bilateral ventilation tube, there was postoperative improvement in audiometry and tympanometry in most cases.

Progress in middle ear dysventilation research / 中华耳鼻咽喉头颈外科杂志

Disfunction of Eustachian tube will cause negative pressure of middle ear, which may result in tympanic membrane retraction pocket. Severe pocket can consequently cause cholesteatoma. In clinical practice it is not uncommon to find a cholesteatoma limited to epitympanum, with an otherwise normal pars tensa and mesotympanum. This review explains the theory of "selective epitympanic dysventilation syndrome" developed by endoscopic technique. In the majority of the patients, the only ventilation pathway to the epitympanum is through the tympanic isthmus. Even if Eustachian tube function has recovered, an isthmus blockage with selective epitympanic dysventilation may lead to common attic cholesteatoma.

Extended Epitympanotomy for Facial Nerve Decompression as a Minimally Invasive Approach

For a minimally invasive approach to access the facial nerve, we designed an extended epitympanotomy via a transmastoid approach that has proven useful in cases of traumatic facial nerve palsy and pre-cholesteatoma. To evaluate the surgical exposure through an extended epitympanotomy, six patients with traumatic facial nerve palsy were enrolled in this study. The same surgical technique was used in all patients. Patients were assessed and the degree of facial nerve paralysis was determined prior to surgery, 1-week post-operatively, and 6-months post-operatively using the House-Brackmann grading system. In all cases, surgical exposure was adequate. All patients with traumatic facial nerve palsy were male and the age range was 13 to 83 years. In all cases, the location of the facial nerve damage was limited to the area between the first and second genu. Symptoms of all the patients improved by 6 months post-operation (p=0.024). There were no complications in any of the patients. Extended epitympanotomy is useful for safe, rapid surgical exposure of the attic area, sparing the patient post-operative dimpling, skin incision complications, and lengthy exposure to anesthesia. We suggest that surgery for patients with facial nerve palsy secondary to trauma be performed using this described technique.

Water protection in patients with tympanostomy tubes in tympanic membrane: a randomized clinical trial / Proteção auricular da água em pacientes com tubo de ventilação em membrana timpânica: ensaio clínico randomizado

ABSTRACT Objective To analyze the incidence of otorrhea in the postoperative period of patients submitted to tympanotomy to place ventilation tube, and who did not protect the ear when exposed to water. Methods Open, randomized-controlled trial. Eighty patients submitted to unilateral or bilateral ear grommet tympanostomy were included and divided into two groups: Auricular Protection and Non-Protection to water during bathing and activities in water. Results In the first postoperative month, the Non-Protection Group presented a significant increase in the number of patients with otorrhea and in the incidence. Four patients of the Protection Group (11%) presented at least one episode of otorrhea in this period, representing an incidence of 0.11 (standard deviation ±0.32) episode/month, whereas in the Non-Protection Group there were 12 episodes (33%; p=0.045) and incidence of 0.33 (±0.48; p=0.02). Between the 2nd and the 13th postoperative months, there was no difference between groups. Seven patients in the Protection Group (20%) had at least one episode of otorrhea, representing an incidence of 0.04 (±0.09) episodes/month, while in the Non-Protection Group there were seven episodes (22%; p=0.8) and incidence of 0.05 (±0.1; p=0.8). Conclusion Patients who underwent ear protection when exposed to water had a lower incidence of otorrhea in the first postoperative month than those who did not undergo protection. From the second month, there was no difference between groups.

RESUMO Objetivo Avaliar a incidência de otorreia no período pós-operatório em pacientes submetidos à timpanotomia para colocação de tubo de ventilação e que não realizaram proteção auricular quando expostos à água. Métodos Ensaio clínico controlado, aberto e randomizado. Foram incluídos 80 pacientes submetidos à timpanotomia para colocação de tubo de ventilação unilateral ou bilateral, divididos em dois grupos: Grupo Proteção e Grupo Não Proteção auricular da água durante o banho e as atividades aquáticas. Resultados No primeiro mês pós-operatório, o Grupo Não Proteção apresentou aumento significativo tanto no número de pacientes com otorreia quanto na incidência. Quatro pacientes do Grupo Proteção (11%) apresentaram ao menos um episódio de otorreia neste período, representando incidência de 0,11 (desvio padrão ±0,32) episódio/mês, enquanto no Grupo Não Proteção ocorreram 12 episódios (33%; p=0,045) e incidência de 0,33 (±0,48; p=0,02). Entre o 2º e o 13º meses pós-operatórios, não houve diferença entre os grupos. Sete pacientes do Grupo Proteção (20%) apresentaram ao menos um episódio de otorreia, representando incidência de 0,04 (±0,09) episódios/mês, enquanto no Grupo Não Proteção foram registrados sete episódios (22%; p=0,8) e incidência de 0,05 (±0,1; p=0,8). Conclusão Pacientes que realizaram a proteção auricular quando expostos à água apresentaram menor incidência de otorreia no primeiro mês pós-operatório do que aqueles que não a realizaram. A partir do segundo mês, não houve diferença entre os grupos.

Microbiological Results From Middle Ear Effusion in Pediatric Patients Receiving Ventilation Tube Insertion: Multicenter Registry Study on the Effectiveness of Ventilation Tube Insertion in Pediatric Patients With Chronic Otitis Media With Effusion: Part

OBJECTIVES: The aim of this multicenter registry study was to investigate the effectiveness of ventilation tube insertion and the microbiology of otitis media with effusion (OME) in children. This part I study was conducted to evaluate the microbiological profile of children with OME who needed ventilation tube insertion. METHODS: Patients < 15 years old who were diagnosed as having OME and received ventilation tube insertion were prospectively enrolled in 16 tertiary hospitals from June 2014 to December 2016. After excluding patients with missing data, the data of 397 patients were analyzed among a total of 433 enrolled patients. The clinical symptoms, findings of the tympanic membrane, hearing level, and microbiological findings were collected. RESULTS: In 103 patients (25.9%), antibiotics were used within 3 weeks before surgery. Ventilation tube insertion was performed in a total of 710 ears (626 in both ears in 313 patients, 55 in the left ear only, and 29 in the right ear only). Culture of middle ear effusion was done in at least one ear in 221 patients (55.7%), and in a total of 346 ears. Only 46 ears (13.3%) showed positive results in middle ear effusion culture. Haemophilus influenzae (17.3%, followed by coagulase-negative Staphylococcus and Staphylococcus auricularis) was the most common bacteria detected. CONCLUSION: H. influenzae was the most commonly found bacteria in middle ear effusion. Relatively low rates of culture positivity were noted in middle ear effusion of patients with OME in Korea.

Risk factors for persistent otitis media with effusion in children: a case-control study / 영남의대학술지

BACKGROUND: Otitis media with effusion (OME) is defined as middle ear effusion without acute signs of infection. OME usually resolves spontaneously; however, persistent OME may require the insertion of a ventilation tube. This study investigated risk factors for persistent OME in children who undergo ventilation tube insertion.METHODS: Children who were admitted to undergo ventilation tube insertion at Jeju National University Hospital between August 2015 and July 2016 were enrolled as the case group. Healthy children without persistent OME from August 2016 to July 2017 were enrolled as the control group. Baseline characteristics and predisposing factor data were collected using an interview questionnaire. Middle ear fluids were collected from the case group.RESULTS: A total of 31 patients underwent ventilation tube insertion. The mean age of the case group was 4.53 years, with a male-to-female ratio of 21:10. Twenty-nine (93.5%) children attended a daycare center, and 21 (67.7%) had experience with bottle feeding. Fifteen (48.4%) children in the case group and 3 (9.7%) in the control group first attended a daycare center at < 1 year of age (odds ratio=9.96; 95% confidence interval=2.44–39.70; p=0.001). No bacteria were found in middle ear fluid collected from the 31 operated children. Nasopharyngeal bacterial colonization was found in 13 (41.9%) and 17 (54.8%) children in the case and control groups, respectively.CONCLUSION: Earlier attendance at a daycare center was the only predisposing factor for ventilation tube insertion in our study. The aseptic nature of middle ear fluids found in children with OME highlights the efficacy of antimicrobial use.

Assessment of Eustachian tube function in patients with tympanic membrane retraction and in normal subjects / Avaliação da função da tuba de Eustáquio em pacientes com retração de membrana timpânica e em indivíduos normais

Abstract Introduction The diagnosis of Eustachian tube dysfunctions is essential for better understanding of the pathogenesis of chronic otitis media. A series of tests to assess tube function are described in the literature; however, they are methodologically heterogeneous, with differences ranging from application protocols to standardization of tests and their results. Objective To evaluate the variation in middle ear pressure in patients with tympanic membrane retraction and in normal patients during tube function tests, as well as to evaluate intra-individual variation between these tests. Methods An observational, contemporary, cross-sectional study was conducted, in which the factor under study was the variation in middle ear pressure during tube function tests (Valsalva maneuver, sniff test, Toynbee maneuver) in healthy patients and in patients with mild and moderate/severe tympanic retraction. A total of 38 patients (76 ears) were included in the study. Patients underwent tube function tests at two different time points to determine pressure measurements after each maneuver. Statistical analysis was performed using SPSS software, version 18.0, considering p-values <0.05 as statistically significant. Results Mean (standard deviation) age was 11 (2.72) years; 55.3% of patients were male and 44.7% female. The prevalence of type A tympanogram was higher among participants with healthy ears and those with mild retraction, whereas type C tympanograms were more frequent in the moderate/severe retraction group. An increase in middle ear pressure was observed during the Valsalva maneuver at the first time point evaluated in all three groups of ears (p = 0.012). The variation in pressure was not significant either for the sniff test or for the Toynbee maneuver at the two time points evaluated (p ≥ 0.05). Agreement between measurements obtained at the two different time points was weak to moderate for all tests in all three groups of ears, and the variations in discrepancy between measurements were higher in ears with moderate/severe tympanic retraction. Conclusion In this study population, the mean pressure in the middle ear showed significant variation only during the Valsalva maneuver at the first time point evaluated in the three groups of ears. Normal ears and those with mild retraction behaved similarly in all tests. The tested maneuvers exhibited weak to moderate intra-individual variation, with the greatest variation occurring in ears with moderate/severe retraction.

Resumo Introdução O diagnóstico das disfunções da tuba auditiva é essencial para o melhor entendimento da patogênese da otite média crônica. A literatura descreve uma série de testes que avaliam a função tubária; contudo, tais exames são metodologicamente heterogêneos, com diferenças que variam desde os protocolos de aplicação até a padronização dos exames e seus resultados. Objetivo Avaliar a variação na pressão na orelha média em pacientes com retração da membrana timpânica e em indivíduos normais durante os testes de função tubária e também avaliar a variação intraindividual desses testes. Método Estudo observacional do tipo transversal e contemporâneo, no qual o fator em estudo foi a variação na pressão na orelha média durante os testes de função tubária (manobra de Valsalva, Sniff Test e manobra de Toynbee) em indivíduos normais e em pacientes com retrações timpânicas leves e moderadas/graves. Foram incluídos 38 pacientes (76 orelhas). Os pacientes foram submetidos, em dois momentos diferentes, a testes de função tubária para determinar as medidas de pressão após cada manobra. A análise estatística foi feita com o programa SPSS, versão 18.0, e consideramos como estatisticamente significativos os valores de p < 0,05. Resultados A média ± desvio padrão da idade foi de 11 ± 2,72 anos; 55,3% dos pacientes eram do gênero masculino e 44,7% do feminino. A prevalência de curvas timpanométricas do tipo A foi mais alta entre os participantes com orelhas normais e naqueles com retrações leves, enquanto as curvas timpanométricas do tipo C foram mais frequentes no grupo com retrações moderadas/graves. Observamos pressões aumentadas na orelha média durante a manobra de Valsalva no primeiro momento da avaliação nos três grupos de orelhas (p = 0,012). A variação na pressão não foi significativa para o Sniff Test, nem para a manobra de Toynbee nos dois momentos de avaliação (p ≥ 0,05). Consideramos que a concordância entre as determinações obtidas nos dois momentos diferentes foi fraca a moderada para todos os testes nos três grupos de orelhas e as variações em termos de discrepância entre as medidas foram maiores nas orelhas com retrações timpânicas moderadas/graves. Conclusão Na população estudada, a média das pressões na orelha média apresentou variação significante apenas durante a manobra de Valsalva no primeiro momento de avaliação, nos três grupos de orelhas. As orelhas normais e aquelas que apresentavam retração leve se comportaram de maneira similar nos testes. As manobras testadas exibiram uma variação intraindividual fraca a moderada e a maior variação ocorreu nas orelhas com retrações moderadas/graves.

The application of tympanic membrane plus adenoidectomy in children with secretoryotitis media / 中国基层医药

Objective To explore the application effect of grommet insertion and adenoidectomy application effect in the treatment of children with secretory otitis media.Methods 64 children with secretory otitis media were randomly divided into two groups,32 cases in the observation group,32 cases in the control group.The control group used a simple tympanic membrane in the treatment of catheter,the observation group was treated with grommet insertion and adenoidectomy,follow-up 6 months curative effect were observed.Results The control group,the observation group after treatment backbone transmission difference were (12.1 ± 1.9)dB,(4.5 ± 1.2)db,two groups of backbone transmission errors were significantly lower than that before treatment (t =4.432,5.357,all P ＜ 0.05),compared with the control group,the observation group was significantly lower (t =10.299,P ＜ 0.05).The control group,the observation group of eustachian tube function recovery rate were 25.0%,68.8%,there was significant difference between two groups (x2 =3.96,P ＜ 0.05).Total effective rate in the observation group was 93.8 %,which was higher than 71.9% in the control group(x2 =5.42,P ＜ 0.05).Conclusion Tympanic membrane and adenoidectomy in the treatment of children with secretoryotitis media has significant effect.

Relação entre área e volume da mastoide em adultos brasileiros / Mastoid surface area-to-volume ratios in adult Brazilian individuals

As medidas de área e volume da mastoide por tomografia computadorizada não foram previamente descritas em adultos brasileiros. O conhecimento dessas medidas é muito importante para o entendimento da fisiologia da orelha média e seus estados patológicos, refletindo diretamente na pneumatização mastoídea. OBJETIVO: Verificar a existência de relação entre a área e o volume da mastoide. MÉTODO: Estudo de coorte contemporânea com corte transversal, no qual 28 pacientes foram submetidos à tomografia de mastoides. Foram reconstruídas as medidas de área e volume das mastoides por cortes seriados usando o software Image Pro Plus. RESULTADOS: Os volumes das mastoides variaram de 5,5 até 72,4 cm³. As áreas variaram de 43,9 até 525,2 cm². A área da mastoide foi uma função linear do volume. CONCLUSÃO: As medidas de área e volume da mastoide em adultos brasileiros seguem uma correlação linear, concordando com estudos realizados em outros países. As médias de área e volume encontradas foram superiores às previamente publicadas, ao contrário da média da relação área/volume, que foi inferior. Futuros estudos, com número maior de indivíduos, poderão esclarecer se a população brasileira tem ou não maiores médias de área e volume da mastoide em relação a outras populações específicas.

Computed tomography-based measurements of mastoid surface area and volume have not been described for adult Brazilian individuals. These measurements add to the understanding of middle ear physiology, related diseases, and their impact on mastoid pneumatization. OBJECTIVE: To check the ratio between mastoid surface area and volume. METHOD: This contemporary cross-sectional cohort study included 28 patients submitted to CT imaging of the mastoid. Measurements of surface area and volume were made based on serial CT scans and produced with the aid of software package Image Pro Plus. RESULTS: Mastoid volumes ranged from 5.5 to 72.4 cm³. Surface areas ranged from 43.9 to 525.2 cm². Surface areas varied linearly with volumes. CONCLUSION: Mastoid surface areas and volumes of adult Brazilian subjects followed a linear correlation, as also described in studies carried out in other countries. Mean surface areas and volumes were higher than previously published, unlike surface area-to-volume ratios, which were lower. Further studies with larger populations will provide evidence as to whether Brazilian subjects have larger surface areas and volumes than other populations.

O padrão facial é fator predisponente para otite média com efusão em crianças? / Is facial pattern a predisposing factor for otitis media with effusion in children?

Anormalidades na morfologia craniofacial são associadas à disfunção da tuba auditiva e a otite média com efusão (OME). OBJETIVO: Avaliar a relação entre o padrão facial, direção do crescimento craniofacial e OME em crianças com tonsilas faríngea e palatinas aumentadas (TFPA). CASUÍSTICA E MÉTODOS: Estudo clínico prospectivo em 79 crianças (41 meninos e 38 meninas), com idades de 4 a 10 anos, com TFPA (níveis III e IV de Brodsky). O grupo de estudo foi composto por 40 crianças com OME, enquanto que o grupo controle foi composto por 39 crianças sem OME. Foi realizada análise cefalométrica. RESULTADOS: Não houve correlação entre o padrão facial e a OMS (c 2 = 0,25 p = 0,88). O grupo com OME apresentou Eixo Facial maior (F(1,75) = 3,68 p = 0,05), e uma Altura Facial Inferior menor (F(1, 75) = 3,99 p = 0,05) quando comparados ao grupo controle. CONCLUSÕES: Não houve correlação entre o padrão facial e a OME em crianças com TFPA, ainda que um padrão facial mais horizontal associado à altura facial inferior diminuída foi consistentemente observada. Isto sugere que um posicionamento anormal do tuba auditiva influencia o desenvolvimento da OME em crianças com TFPA.

Abnormalities in craniofacial morphology are associated with Eustachian tube dysfunction and otitis media with effusion (OME). AIM: to evaluate the relationship between facial pattern and craniofacial growth direction, and OME in children with enlarged tonsils and adenoids (ETA). METHODS: Clinical prospective survey in 79 children (41 male and 38 female), ranging from 4 to 10 years of age, with tonsil and adenoid enlargement (Brodsky's grades III and IV). Forty children presented with OME (study group) and 39 did not (control group). Cephalometric analysis was used to determine the facial pattern. RESULTS: There was no correlation observed between facial pattern and OME (c 2 = 0.25 p = 0.88). Facial Axis was larger in the OME group (F(1.75) = 3.68 p = 0.05) and the Lower Anterior Facial height was smaller (F(1. 75) = 3.99 p = 0.05) in children with otitis media with effusion. CONCLUSIONS: There was no correlation between OME and facial pattern in children with ETA although a more horizontal facial growth direction, and a smaller lower anterior facial height was observed consistently among subjects in this group. This suggests that abnormal positioning of the eustachian tube influences the development of OME in children with ETA.

Avaliação de resultados e complicações da cirurgia de colocação de tubos de ventilação em pacientes com otite media serosa / Evaluation of the results and complications of the ventilation tubes' setting surgery in patients with serous otitis media

Introdução: Timpanotomia para colocação de tubo de ventilação é uma das cirurgias mais frequentes realizadas em pacientes na faixa etária pediátrica. Objetivo: Esse estudo avalia indicações e complicações pós-operatórias mais frequentes nesta prática otorrinolaringológica em um hospital escola. Método: Foi realizado um estudo retrospectivo tipo série de casos no qual 109 pacientes pediátricos, que receberam tubos de ventilação, foram avaliados quanto à indicação e acompanhamento pós-operatório pelo setor de otorrinolaringologia da Escola Paulista de Medicina durante os anos de 2007 a 2008. Resultados: A idade média encontrada foi de 7,37 anos, sendo a maioria dos pacientes do sexo masculino (59,63%). Todos os casos tiveram como indicação cirúrgica otite média serosa. As taxas de complicações encontradas foram menores que as relatadas pela literatura com 3,43% de perfuração residual com necessidade de reintervenção cirúrgica e 5,47% não apresentaram melhora audiométrica, necessitando de nova inserção de tubo de ventilação. Conclusão: Os resultados encontrados sugerem que em nosso serviço há menores taxas de otorreia pós-operatória, reinserção de tubos, menor número de tubos removidos cirurgicamente e taxa semelhante de perfurações residuais que a descrita na literatura para a cirurgia de colocação de tubo de ventilação em pacientes com OMS.

Introduction: Tympanostomy for ventilation tube setting is one of the surgeries more frequent performed in patients in the pediatric age group. Objective: This study evaluates the indications and complications post operatives more frequents in this otorhinolaryngological practice in a school hospital. Method: It was realized a series type retrospective study of cases in which 109 pediatric patients, that have received ventilation tube were evaluated as for the post operative indication and attendance for the otorhinolaryngology sector of the Paulista Medicine School for 2007 to 2008. Results: The age' average found was 7,37 years, being the majority of the patients of the male sex (59,63%). All the cases have had as surgical indication serous otitis media. The taxes of complications found were lower than those related for the literature with 3,43% of residual perforation with necessity of surgical re intervention and 5,47% do not presented a audiometric improvement needing a new insertion of ventilation tube. Conclusion: The results found suggest that in our service there are lower rates of postoperative otorrhea, tube reinsertion, less tubes surgically removed and a similar rate of residual perforations that that one described in the literature for surgical placement of ventilation tubes in patients with SOM.

Pre-operative Evaluation of Eustachian Tube Function Using a Modified Pressure Equilibration Test is Predictive of Good Postoperative Hearing and Middle Ear Aeration in Type 1 Tympanoplasty Patients

OBJECTIVES: The Eustachian tube (ET) plays an important role in maintaining a normally aerated middle ear. Inflammation in middle ear disease is related to ET dysfunction, and postoperative restoration of middle ear integrity and hearing are closely related to ET function in chronic ear disease patients. After successful tympanoplasty, restoration of a well-aerated middle ear with good ET function can permit better compliance of the tympanic membrane. In this study, we evaluated the predictive validity of preoperative ET function measurements. METHODS: We reviewed 137 patients who underwent type 1 tympanoplasty. All patients had non-cholesteatomatous chronic otitis media and received canal wall-up-type tympanomastoidectomies. Patients were categorized into four groups according to preoperative ET function measurements using a modified pressure inflation-deflation equilibration test. Group I patients had residual pressures less than 10 daPa, and Group IV patients showed no pressure change (poor results). Groups II and III were intermediate. Hearing levels were determined using pure tone averages at four frequencies. Postoperative tympanography was performed to determine middle ear aeration. RESULTS: The preoperative air bone (AB) gap was 29.6+/-7.0 dB, and the postoperative gap was 16.5+/-5.7 dB; thus, there was significant overall improvement. In all groups, hearing was significantly better after surgery, but the worst postoperative hearing level was seen in Group IV patients. Type B tympanograms were more frequently recorded in Group IV patients than they were in Group I or II patients. Postoperative AB gaps were 9.2+/-3.8 dB in patients with type A tympanograms, 13.4+/-2.1 dB in those with type As, 24.1+/-2.5 dB in those with type C, and 18.5+/-2.8 dB in those with type B. CONCLUSION: ET function measured with a modified pressure equilibration test using an inflation-deflation manometric method is a good indicator of an aerated middle ear and is predictive of improved postoperative hearing.

Self-retaining harpoon tympanostonomy tube with applicator

Objective: To describe a novel harpoon design for a low cost, self retaining tympanostomy tube with applicator used in a 38-year-old female for otitis media with effusion. Methods: a. Study design: Instrumental Innovation/Case Report b. Setting: Tertiary Hospital in Metro Manila Results: The tympanostomy tube was inserted under endoscopic guidance within 10 seconds, remained in place for two months with relief of symptoms, and spontaneously extruded by the seventh month of follow-up. Conclusion: The harpoon-designed tube with applicator provided ease of insertion and good anchorage in the tympanic membrane. Maximizing the use of a stylet-needle as both perforator and applicator simplified the tympanostomy and ventilating tube insertion procedures into a single maneuver. (Author)

The Rate of General Anesthesia after Laser Tympanostomy with Ventilation Tube Insertion: A Prospective Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study is to evaluate if laser tympanostomy (LT) flexibly combined with ventilation tube insertion(VT) would result in the decreased rate of general anesthesia. This approach (LT+VT) would be an initial surgical approach for children with otitis media with effusion (OME). SUBJECTS AND METHOD: We made a prospective study that enrolled all the children with bilateral otitis media with effusion (OME) eligible for surgical intervention from January 2003 to December 2003, and 12 months postoperative follow-up. Laser tympanostomy under topical anesthesia was followed by VT insertion in the cooperative children. The success of treatment was defined as VT insertion under topical anesthesia or management of MEE without general anesthesia for 12 months. RESULTS: 79 children with bilateral OME were included. Overall cooperation to bilateral laser tympanostomy was 87%. Further cooperation to 1st VT was possible in 73% and 2nd VT in 45%. Overall efficacy of LT+VT was 91%. VT insertion on the cooperative children was presumed to increase the efficacy of laser tympanostomy by 24%. LT with VT might eliminate 80% of general anesthesia and the rate of G/A was 20% in our hospital. The rate of general anesthesia decreased to 9% when the child tolerated LT on both ears and to only 3% when the child tolerated at least one VT. CONCLUSION: LT with VT insertion might help to maintain high cooperation rate (87%), improved efficacy (91%), and therefore could reduce the rate of general anesthesia. LT+VT used under topical anesthesia might be an initial surgical approach for all OME children if the surgeon is willing to.

Treatment Outcome of Laser Tympanostomy with Ventilation Tube Insertion under Topical Anesthesia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study is to find out whether laser tympanostomy (LT) with tympanostomy tube (TT) insertion has some potential role for the treatment of children with chronic otitis media with effusion (OME) under the topical anesthesia. SUBJECTIVES AND METHOD: We prospectively enrolled 89 OME children (2-7 yrs old, 139 ears) for LT with TT insertion under topical anesthesia. Following LT, TT insertion was done if the middle ear effusion was mucoid or if middle ear mucosa was inflammed, or if the child had poor prognostic factors. RESULTS: Ninety-four ears (68%) had mucoid effusion, 18 ears (13%) serous effusion, 11 ears (8%) purulent effusion, and 16 ears (12%) were dry. It was determined that TT insertion was not necessary in 26 ears (19%). TT insertion into the laser tympanostomy opening was tried on the other 113 ears. TT insertion had a success rate of 81% (91/113). After 3 months of follow-up, LT that did not need TT insertion showed 81% (21 ears) resolution rate. Therefore, the total efficacy of LT with TT insertion under topical anesthesia was 85%. CONCLUSION: Laser tympanostomy with TT insertion resulted in increased efficacy. Also, compared to knife myringotomy, it seems to have a potential role for lowering the age group of OME children whom can be managed under topical anesthesia.

Clinical Diagnostic Accuracy of Otitis Media with Effusion in Children, and Significance of Myringotomy: Diagnostic or Therapeutic?

The specific aims of this prospective survey were to determine the accuracy of traditional diagnostic tools, such as pneumatic otoscopy, otomicroscopy, and tympanometry, and evaluate the usefulness of myringotomy as a diagnostic method; also to determine the significance of myringotomy in treating otitis media with effusion (OME). The status of middle ear of 51 children (85 ears) from November 2002 to February 2003 was examined using pneumatic otoscopy, otomicroscopy, and tympanometry, and the presence/absence of middle ear effusion was confirmed by myringotomy. The otomicroscopy was the most sensitive and specific one among three diagnostic tools. But, it had some false positive cases. This study failed to show the therapeutic efficacy of myringotomy. Otomicroscopy seems to have the potential to become the standard for diagnosis of OME and for validation of pneumatic otoscopy in children. However, when otoscopic, otomicroscopic findings and tympanogram of suspected ear show poor correlation, myringotomy can be used to confirm the presence of OME, as the diagnostic modality. As the therapeutic modality, we think that it is proper to limit indications of myringotomy to some selected cases.