Surgery for Otitis Media with Effusion: A Survey of Otolaryngologists Who Treat Children in Brazil

Abstract Introduction Myringotomy and ear tube placement (MTP) is the surgical treatment for otitis media with effusion (OME), and it is the most common surgery performed in children. Several guidelines have been developed to assist in the care of patients who become candidates for MTP. Objectives To evaluate the practice of Brazilian otorhinolarynogologists when performing MTP according to the years of clinical experience. Secondarily, we also want to assess if their practice regarding MTP varied according to the percentage of children treated and the location of their practice. Methods A 30-question survey was sent to otolaryngologists affiliated with the Brazilian Academy of Pediatric Otorhinolaryngology (Academia Brasileira de Otorrinolaringologia Pediátrica, ABOPe, in Portuguese) and/or the Scientific Department of Otorhinolaryngology of the Brazilian Society of Pediatrics (Sociedade Brasileira de Pediatria, SBP, in Portuguese). The questions included were carefully chosen to provide a profile about the practices adopted in the pre-, peri- and postoperative periods of MTP. Results The questionnaire was sent to 208 otolaryngologists, and there were 124 (59.6%) respondents. Of those, 59.7% use antiseptics before surgery. Only 54 otolaryngologists, less than half of the subjects in this study (43.5%), always place a tube during the procedure. More physicians who practice in small cities recommend water precautions after MTP when compared to other physicians (p < 0.001). Conclusions The present study reveals that many respondents do not follow some of the recommendations of the current guidelines of the American Academy of

Water protection after tympanostomy (Shepard) tubes does not decrease otorrhea incidence - retrospective cohort study / Proteção contra a água após colocação de tubos de ventilação (Shepard) não diminui a incidência de otorreia - estudo retrospectivo de coorte

Abstract Introduction Myringotomy for tube insertion is the most common otologic surgery. Otorrhea is a frequent complication of this procedure and, to prevent it, most surgeons strongly recommend avoiding contact with water as this is thought to adversely impact on post-operative quality of life. Objective To understand the benefit of this recommendation. Methods Observational study - retrospective cohort study comparing the incidence of post-operative otorrhea and its impact on patients' quality of life, in two groups of patients comprising children under 10 years of age who underwent bilateral myringotomy and tube placement for chronic otitis media with effusion between May 2011 and May 2012. One group received water protection care after surgery, the other did not. Data was collected through telephonic interview, after one year of follow up (one year after the procedure). Water exposure without protection was considered the exposure event. Incidence of otorrhea and perceived impact on quality of life were the outcome measures. Results were compared after logistic regression. Results We included 143 children: 116 were not exposed to water without protection and 27 were exposed. In the not exposed group 36.2% had at least one episode of otorrhea, compared to 40.0% of the exposed group. Odds ratio for otorrhea on exposed was 1.21 (95% CI 0.51-2.85, p = 0.6). Negative impact on quality of life was reported by parents of 48.2% on the not exposed children, compared to 40.7% on the exposed group. This difference was not significant (p = 0.5). Conclusion We found that recommending water protection did not have beneficial effect on the incidence of otorrhea after myringotomy with tubes on chronic otitis media with effusion. However, such measures did not appear to have a negative impact on quality of life. This is a populational observational study with few cases (143 cases); these final statements would be better stated by a very large populational study with another large control group.

Resumo Introdução A miringotomia para inserção de tubo de ventilação é a cirurgia otológica mais comum. Otorreia é uma complicação frequente deste procedimento e, para evita-la, a maioria dos cirurgiões recomenda evitar o contato com a água, pois acredita-se que isso possa afetar negativamente a qualidade de vida pós-operatória. Objetivo Verificar o benefício dessa recomendação. Método Estudo observacional - estudo de coorte retrospectivo, comparando a incidência de otorreia pós-operatória e seu impacto na qualidade de vida dos pacientes, em dois grupos de pacientes com crianças menores de 10 anos submetidas à miringotomia bilateral e colocação de tubo de ventilação para o tratamento de otite média crônica com efusão, entre maio de 2011 e maio de 2012. Um grupo recebeu cuidados de proteção contra a água após a cirurgia, o outro não. Os dados foram coletados através de entrevista telefônica, após um ano de seguimento (um ano após o procedimento). A exposição à água sem proteção foi considerada o evento de exposição. A incidência de otorreia e o impacto percebido na qualidade de vida foram as medidas de resultado. Os resultados foram comparados após a regressão logística. Resultados Incluímos 143 crianças: 116 não foram expostas à água sem proteção e 27 foram expostas. No grupo não exposto, 36,2% apresentaram pelo menos um episódio de otorreia, em comparação com 40,0% do grupo exposto. A razão de chances (odds ratio) para otorreia no grupo exposto foi de 1,21 (IC 95%: 0,51-2,85, p = 0,6). O impacto negativo na qualidade de vida foi relatado pelos pais de 48,2% nas crianças não expostas, em comparação com 40,7% no grupo exposto. Essa diferença não foi significante (p = 0,5). Conclusão Não verificamos um efeito benéfico sobre a incidência de otorreia ao recomendar a proteção contra a água após colocação de tubos de ventilação para otite média com efusão. Entretanto, tais medidas não parecem ter tido um impacto negativo na qualidade de vida.

Comparative hearing outcomes of tympanostomy tubes and combined with adenoidectomy for pediatric otitis media effusion treatment:a Meta-analysis / 实用医学杂志

Objective To investigate the hearing outcome efficiency of tympanostomy tubes and when combined with adenoidectomy for otitis media with effusion treatment. Methods A systematic literature review of tympanostomy tubes and tympanostomy tubes combined with adenoidectomy were performed using PubMed, EMBASE,the Cochrane Library,MEDLINE,all of the included studies were randomized controlled trial. The quality of included studies was evaluated according to the Risk of Bias Table of the Cochrane Handbook. Data were analyzed with Review Manager 5.02 software. Heterogeneity was examined,and forest plot was drawn. Results All of the included 4 studies were randomized controlled trials. At 6 month follow-up patients,the tym-panostomy tubes and tympanostomy tubes combined with adenoidectomy had no difference in hearing improvement (WMD = 1.06,95%CI-0.18 ~ 2.29,P = 0.09). At 12 month follow-up patients,the tympanostomy tubes com-bined with adenoidectomy were better than tympanostomy tubes alone(WMD = 3.03,95%CI 0.91 ~ 5.14,P =0.005). Conclusions The meta analysis result reveals that tympanostomy tubes combined with adenoidectomy have an advantage in long term follow up time for hearing improvement in children's otitis media with effusion treatment.

The Relation between Tympanostomy Tube Otorrhea and Types of Immune Cells in Middle Ear Effusion in Children with Otitis Media with Effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tympanostomy tube insertion is one of the most common surgical procedures in children. Despite aseptic procedures with prophylactic antibiotic treatment, postoperative otorrhea may be encountered in some patients. The purpose of this study is to identify the relation between the types of immune cells in otitis media with effusion (OME) and tympanostomy tube otorrhea (TTO) in children. SUBJECTS AND METHOD: Fifty-six patients underwent tympanostomy tube insertion with OME were analyzed retrospectively. Fluid from OME was harvested by suction via syringe connector after myringotomy. Light microscopic examination of middle ear effusion was performed by a pathologist after hematoxylin and eosin staining. We analyzed the relation between the types of immune cells from middle ear effusion and TTO. RESULTS: Of 56 children, 36 were male and 22 were female. The mean age for tympanostomy tube insertion was 3.56 (±2.63) years, with the average follow-up period of 12.56 (±9.96) months. Neutrophils were detected in 19, eosinophils in 14, lymphocytes in 22, mast cells in 2, plasma cells in 7, and histiocytes in 9. TTO occurred in 15 patients. In patients with early TTO, eosinophils were detected more frequently than in patients without TTO (p=0.006). Plasma cells were detected more frequently in patient with late TTO than without TTO (p=0.011). CONCLUSION: According to the analysis of different types of immune cells, eosinophils in the middle ear effusion related with the occurrence of TTO.

Optical myringotomy knife

@#<p style="margin: 0in 0in 0.0001pt; text-align: justify; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; vertical-align: baseline;"><b>Objective:</b> To describe an improvised optical myringotomy knife essential in creation of an incision in a myringotomy simulator.</p><p class="MsoNormal" style="margin-bottom: .0001pt; text-align: justify; line-height: normal; mso-layout-grid-align: none; text-autospace: none;"><b>Methods:</b></p><p class="MsoNormalCxSpMiddle" style="mso-add-space: auto; text-align: justify; line-height: normal; mso-layout-grid-align: none; text-autospace: none; margin: 0in 0in .0001pt .5in;"><b>Study Design: </b>Instrumental Innovation </p><p class="MsoNormalCxSpMiddle" style="mso-add-space: auto; text-align: justify; line-height: normal; mso-layout-grid-align: none; text-autospace: none; margin: 0in 0in .0001pt .5in;"><b>Setting:          </b>Tertiary Private Hospital</p><p class="MsoNormalCxSpMiddle" style="mso-add-space: auto; text-align: justify; line-height: normal; mso-layout-grid-align: none; text-autospace: none; margin: 0in 0in .0001pt .5in;"><b>Subject:</b>          None</p><p class="MsoNormalCxSpLast" style="margin-bottom: .0001pt; mso-add-space: auto; text-align: justify; line-height: normal; mso-layout-grid-align: none; text-autospace: none;"><b>Results:</b> The optical myringotomy knife was able to create incisions on mock membranes made up of polyethylene film (Cling Wrap) in a myringotomy simulator. The incisions measured approximately 2 mm with sharp edges indicating that the myringotomy knife was able to penetrate the mock membrane with ease. It provided good control in performing myringotomy incisions under endoscopic visualization of the tympanic membrane.  </p><p style="margin: 0in 0in 0.0001pt; text-align: justify; line-height: 200%; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; vertical-align: baseline;"> </p><p style="margin: 0in 0in 0.0001pt; text-align: justify; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; vertical-align: baseline;"><b>Conclusion: </b>Our initial experience with this optical myringotomy knife for tympanostomy tube insertion suggests that it may greatly improve the performance of myringotomy especially among less experienced surgeons. Further studies may establish its accuracy and replicability <i>in vitro</i>, after which formal <i>in vivo</i> trials can be attempted.</p>

Effect of tympanostomy tube insertion or tympanocentesis on transnasal endoscopic adenoidectomy in the treatment of pediatric patients with secretory otitis media / 重庆医学

Objective To discuss the tympanic membrane puncture or tympanostomy tube under endotoscope combined with adenoidectomy under nasal endoscopy on the influence of invalid conservative treatment of pediatric secretory otitis media.Methods A total of 112 cases of secretory otitis media with invalid conservative treatment were selected in the department of otorhinolaryngology of children′s hospital of Nanjing Medical University from July 2013 to August 2015.They were divided into three groups,the group A of 38 cases(68 ears)underwent transnasal endoscopic pure adenoidectomy;the group B of 37 cases(60 ears)underwent transnasal endoscopic adenoidectomy combined with tympanocentesis;the group C of 37 cases(59 ears)underwent tympanostomy tube insertion.The clinical treatment effect,the period of middle ear effusion,postoperative recurrence and complication were observed and compared.Results The total effective rate of the 3 groups was improved after 3 months(P<0.05);the total effective rate in group B and group C at one week and 3 months after operation were higher than those of group A(P<0.05);and the total effective rate in group C at 3 months after operation was significantly higher than that of group B(P<0.05).The level of auditory brainstem evoked potential(ABR)and the latency of ABR wave Ⅰ latency were decreased at 1 year after operation(P<0.05);the ABR changes in group B and group C at 1 week and 1 year after operation were lower than those in group A(P<0.05).The incidence of recurrence rate and the period of middle ear effusion in group C were lower than those in group A and B(P<0.05).The incidence of complication of group A was lower than those of group B and group C(P<0.05).Conclusion Using tympanostomy tube combined with adenoidectomy under endoscope can improve the children with hearing,which not only can shorten the time of the middle ear effusion,but also effectively reduce the recurrence rate.

How do You Select an Anesthesia Method Prior to Tympanostomy Tube Insertion for a Child?

The use of general (face-mask inhalation and intravenous) anesthesia has been the method of choice for tympanostomy tube insertion in children. However, there is no exact guideline for the choice of anesthesia method and there is no evidence to support the use of one anesthesia method over another. Clinically, the anesthesia method used to be decided by old customs and the surgeon's blind faith that children cannot bear tympanostomy tube insertion under local anesthesia. Clinicians should keep in mind that pediatric anesthesia has a potential risk. Despite infrequent serious complications, their seriousness necessitates that sedation or general anesthesia should be done by an anesthesiologist and thus children requiring tympanostomy tube insertion should be referred to secondary or tertiary hospitals, even if they have been followed by a primary care physician for a long time. Previous evidence showed that local anesthesia is appropriate for tympanostomy tube insertion in selected children, especially in children older than 5 years are older. Proper choice of anesthesia method is helpful for both patient and medical service provider. Local anesthesia can give psychological relief to children and their parent. It is easier for the medical service providers to schedule the operation and allocate the medical resources in their hospital. Local anesthesia can reduce individual, social, and national burdens for the health care services.

Comparison between auripuncture or tympanostomy tubes combined with adenoidectomy in children with otitis media with effusion / 中国耳鼻咽喉头颈外科

OBJECTIVE To compare the clinical efficacy between adenoidectomy combined with auripuncture (AT+A) and adenoidectomy combined with tympanostomy tubes (AT+T) in children wiht otitis media with effusion. METHODS 92 cases of children with otitis media with effusion were selected from September 2010 to September 2014 in our hospital which was divided into AT+T group and AT+A group, depending on therapy methods.There were 48 in AT+T group and 44 in AT+A group. Retrospective analysis were made on a series of clinical data ,including the therapeutic effect, hearing threshold before and after treatment, infection rate and recurrence rate. RESULTS The hearing threshold has been significantly reduced within one year of follow-up after treatment,however,there was no significant difference (P>0.05). Total efficiency rate was 97.9% in AT+T group and 95.4% in AT+A group, no significant difference was found (P>0.05). The average middle ear fluid duration, infection and recurrence rate of children in AT+T group and AT+A group was (7.3±0.8) days, 6.3%, 4.2% and (11.7±0.4) days, 15.9%, 11.4% respectively, there was significant differences (P<0.05). CONCLUSION Both AT+T and AT +A have a good therapeutic effect for children with otitis media with effusion, which can significantly improve the hearing. Compared to AT+A, AT+T have a higher recovery rate,significantly reduce the recurrence and infection rate,and may be more suitable for clinical treatment of children with otitis media with effusion.

Age as a Determinant to Select an Anesthesia Method for Tympanostomy Tube Insertion in a Pediatric Population

BACKGROUND AND OBJECTIVES: To evaluate the relationship between age and anesthesia method used for tympanostomy tube insertion (TTI) and to provide evidence to guide the selection of an appropriate anesthesia method in children. SUBJECTS AND METHODS: We performed a retrospective review of children under 15 years of age who underwent tympanostomy tube insertion (n=159) or myringotomy alone (n=175) under local or general anesthesia by a single surgeon at a university-based, secondary care referral hospital. Epidermiologic data between local and general anesthesia groups as well as between TTI and myringotomy were analyzed. Medical costs were compared between local and general anesthesia groups. RESULTS: Children who received local anesthesia were significantly older than those who received general anesthesia. Unilateral tympanostomy tube insertion was performed more frequently under local anesthesia than bilateral. Logistic regression modeling showed that local anesthesia was more frequently applied in older children (odds ratio=1.041) and for unilateral tympanostomy tube insertion (odds ratio=8.990). The cut-off value of age for local anesthesia was roughly 5 years. CONCLUSIONS: In a pediatric population at a single medical center, age and whether unilateral or bilateral procedures were required were important factors in selecting an anesthesia method for tympanostomy tube insertion. Our findings suggest that local anesthesia can be preferentially considered for children 5 years of age or older, especially in those with unilateral otitis media with effusion.

Tympanostomy tube under the ear endoscopy combined with adenoidectomy in children with ssecretory otitis media / 中国医学装备

Objective:To evaluate efficacy of tympanic membrane PE tube placement combined with oral endoscopic adenoidectomy in treating otitis media with effusion(OME) in children. Methods:Selected 87 cases(102ears)patients of secretory otitis media as research subjects between January 2012 to August 2014, in department of Otolaryngology in Heilongjiang Province, randomly divided into observation group(45cases, 55ears) and control group(42cases, 47ears),observation group used tympanostomy tube siphon drainage method combined with adenoidectomy for treatment, control group alone tympanostomy tube siphon drainage therapy, postoperative complications recorded data of patients later from the hospital after six and twelve months. Results:Two groups of patients after six months treatment and after twelve months(x2=5.705, x2=7.460;P<0.05), the results were statistically significant(P<0.05);in the middle ear effusion time, recurrent ear number, the number of ear infections, the results were also statistically significant(t=7.662, x2=4.197, x2=4.752;P<0.05). Conclusion:Under the ear drum using endoscopic drainage siphon tube method combined with adenoidectomy can effectively reduce postoperative complications in patients with quick, injury, etc, with high short-term and long-term efficacy, worthy application.

Mupirocin Ointment Prevents Early Post-Tympanostomy Tube Otorrhea: A Preliminary Study

BACKGROUND AND OBJECTIVES: The most common complication of tympanostomy tube (T-tube) insertion is the development of postoperative otorrhea. Post-tympanostomy tube otorrhea (PTTO) is defined as active drainage through an existing T-tube. Many surgeons routinely use topical antibiotics as prophylaxis against early PTTO. Mupirocin calcium ointment is a topical antimicrobial agent with broad-spectrum antimicrobial activity against many Gram-positive organisms. This study evaluated the clinical effectiveness of topical mupirocin ointment in reducing early PTTO. SUBJECTS AND METHODS: The study included 98 ears (67 patients, mean age 32.9 years) that had a T-tube inserted because of chronic middle ear effusion or atelectatic otitis media. A Paparella type-I polyethylene-tube coated with mupirocin was inserted through the tympanostomy. Patients were instructed not to use otic drops or any other medications. All patients were seen by day 14 postoperatively. RESULTS: Early PTTO occurred in one case (1.5%). No early PTTO was seen with a middle ear effusion. Nineteen children were treated under general anesthesia; none developed early PTTO. CONCLUSIONS: Insertion of a T-tube coated with mupirocin ointment could be effective at preventing early PTTO.

Mupirocin Ointment Prevents Early Post-Tympanostomy Tube Otorrhea: A Preliminary Study

BACKGROUND AND OBJECTIVES: The most common complication of tympanostomy tube (T-tube) insertion is the development of postoperative otorrhea. Post-tympanostomy tube otorrhea (PTTO) is defined as active drainage through an existing T-tube. Many surgeons routinely use topical antibiotics as prophylaxis against early PTTO. Mupirocin calcium ointment is a topical antimicrobial agent with broad-spectrum antimicrobial activity against many Gram-positive organisms. This study evaluated the clinical effectiveness of topical mupirocin ointment in reducing early PTTO. SUBJECTS AND METHODS: The study included 98 ears (67 patients, mean age 32.9 years) that had a T-tube inserted because of chronic middle ear effusion or atelectatic otitis media. A Paparella type-I polyethylene-tube coated with mupirocin was inserted through the tympanostomy. Patients were instructed not to use otic drops or any other medications. All patients were seen by day 14 postoperatively. RESULTS: Early PTTO occurred in one case (1.5%). No early PTTO was seen with a middle ear effusion. Nineteen children were treated under general anesthesia; none developed early PTTO. CONCLUSIONS: Insertion of a T-tube coated with mupirocin ointment could be effective at preventing early PTTO.

Colleras obstruidas: ¿Qué hacer?: un modelo experimental ex vivo / Clearing blocked tympanostomy tubes: an ex-vivo model

Introducción: La obstrucción del lumen de las colleras es un evento infrecuente, pero que anula la efectividad del dispositivo en la ventilación del oído medio. Existen múltiples opciones de tratamiento tópico para esta situación clínica, sin embargo, los reportes en la literatura al respecto presentan resultados contradictorios. Objetivos: Analizar la efectividad de distintos tratamientos tópicos para destapar una collera ocluida con coágulo de sangre. Material y método: Modelo experimental ex vivo, 184 tubos de ventilación obstruidos con coágulo de sangre. Tratamiento tópico, 8 grupos experimentales (agua oxigenada 3 por ciento, ácido acético 5 por ciento, ciprofloxacino 0,3 por ciento, vinagre de mesa, heparina, mezcla de H2O2/acetato 1:1, suero fisiológico 0.9 por ciento) y 2 grupos control (sin tratamiento). Revisión de permeabilidad de lumen de colleras a los 3, 7 y 10 días. Resultados: El agua oxigenada (H2O2) resulta ser el tratamiento más efectivo (88 por ciento y 92 por ciento de efectividad a los 7 y 10 días). Ciprofloxacino, vinagre de mesa, suero fisiológico y heparina son inefectivos, sin diferencias significativas con grupo control. Ciprofloxacino y suero fisiológico sedimentan más, e incluso tapan colleras previamente permeables. Conclusiones: H2O2 es un tratamiento seguro, efectivo y económico para destapar colleras obstruidas con coágulos de sangre.

Introduction: Blocked tympanostomy tubes (TT) are an uncommon event, but avoids the effectiveness of this device in middle ear ventilation. Many topical treatment options are available for this clinical situation, however, reports in literature show conflicting results. Aim: Analyze the effectiveness of various topical treatments to open blood clot blocked TT. Material and Method: Ex vivo experimental model. 184 blood clot blocked TT. Topical treatment, 8 experimental groups (3 percent hydrogen peroxide, 5 percent acetic acid, 0,3 percent ciprofloxacin, vinegar, heparin, mixture 1:1 H2O2/acetate, 0.9 percent saline) and 2 control group (no treatment). Review of tube permeability at 3, 7 and 10 days of treatment. Results: H2O2 is the most effective treatment (88 percent & 92 percent effectiveness at 7 & 10 days). Ciprofloxacin, vinegar, saline and heparin are ineffective, with no statistical differences with control group. Ciprofloxacin and saline even blocked previously opened TT. Conclusions: H2O2 is a safe, effective and economic treatment to clear blood clot blocked TT.

Eosinophilic Otitis Media 3 Cases Discovered with Recurrent and Sticky Otorrhea after Ventilation Tube Insertion / 대한이비인후과학회지

We studied three patients in whom otorrhea occurred without bacterial infection following ventilation tube (VT) insertion. These patients took oral steroids since the conventional therapy was not effective; however, the oral steroids produced temporal effect since sticky otorrhea occurred when the oral steroids were stopped. We collected ear discharge from each patient and consulted the pathologist about histopathologic findings of it. We identified the predominant eosinophilic infiltration at specimen. We tried to relate this type of otitis media with eosinophilic otitis media (EOM) and treated the patients with intratympanic steroid injection.

Factors Affecting the Extrusion Rate of Ventilation Tubes

OBJECTIVES: The objective of this study was to determine the various factors that affect the extrusion rate of ventilation tubes (VTs), including the nature of the middle ear effusion. METHODS: A retrospective chart review of 82 pediatric patients (177 ears) who received VT insertion surgery under general anesthesia was carried out to evaluate the relationship between various factors and the VT extrusion rate. The factors we analyzed included age, gender, the adenoid size, the amount and content of the middle ear effusion after myringotomy, bleeding events, associated adenoidectomy and the findings of the tympanic membrane status, the tympanometry and the audiometry of the air bone gap. RESULTS: The mean extrusion time was 254 days (range, 11 to 809 days). The patients with no history of previous VT insertion had a longer extrusion time (mean, 279 days) than did the patients who had undergone previous VT insertion (mean, 203 days). The patients with serous effusion had the shortest extrusion time (mean, 190 days) as compared to those patients with glue (273 days) and pus (295 days) effusions. Other factors had no statistical significant relationship with the extrusion time. CONCLUSION: The mean VT extrusion time was 254 days. The VT extrusion time was significantly related to the characteristics of the middle ear effusion and a history of previous VT insertion. Thus, the nature of middle ear effusion can provide a clinical clue to predict the VT extrusion time.

L'otite seromuqueuse de l'enfant

L'OSM est la cause la plus frequente de surdite acquise de l'enfance. Environ 90des enfants presentent au moins un episode d'OSM avant l'age de 6 ans avec une frequence maximale a l'age de 2 ans. Le developpement de l'OSM peut etre explique par la defaillance d'autres barrieres protectrices (systeme mucociliaire; systeme immunitaire; trompe auditive) qui n'assurent plus de resistance aux bacteries. Le meilleur moyen diagnostic actuel de l'OSM est l'otoscopie pneumatique qui a une sensibilite de 94et une specificite de 80. La tympanometrie sert surtout a documenter l'OSM et a suivre l'evolution. Le traitement de l'OSM ne peut etre envisage que si un benefice persistant et cliniquement significatif est assure par rapport a l'evolution spontanee. Aucun traitement medical n'a fait la preuve de son efficacite. Le traitement deconges- tionnant nasal et les antihistaminiques n'ont montre aucune superiorite par rapport au placebo. Ailleurs; l'indication chirurgicale (ATT) depend de la perte auditive; des symptomes associes; des facteurs de risque au developpement; et de la prevision anticipee du temps de resolution de l'epanchement. Malgre son diagnostic relativement aise; la strategie therapeutique etant controversee. Le traitement n'est justifie que lorsque l'OSM est chronique. L'ATT demeure l'unique traitement efficace. La prevention des causes de l'inflammation est primordiale mais s'avere difficile. Nous nous proposons de resumer les avancees actuelles en epidemiologie; pathogenie; diagnostic et dans la prise en charge de l'OSM

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)

Grommet Cholesteatoma / 대한이비인후과학회지

There are occasional complications after tympanostomy tube insertion due either to the operative procedure itself or to the anato-mical or physiological effects of the tubes. Hearing loss, persisting perforation, tympanosclerosis, atrophy, atelectasis, and the development of cholesteatoma have all been attributed to the tympanostomy tubes. The development of a secondary cholesteatoma at the site of the tube placement Grommet cholesteatoma- is a very uncommon complication. We report one case of cholesteatoma associated with tympanostomy tube insertion.

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.

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.