Vertiginous Episodes in Menière Disease following Transmyringeal Ventilation Tube Insertion: A Systematic Review on the Current State of Evidence

Abstract Introduction Menière disease (MD) is a disorder characterized by episodes of vertigo, sensorineural hearing loss, tinnitus and aural fullness. Objectives To assess the effect of ventilation tube insertion (VTI) on vertiginous episodes in patients (≥ 18 years old) with MD. Data Synthesis A systematic literature search on randomized clinical trials (RCTs), nonrandomized trials and other systematic reviews was performed. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to assess the overall certainty of evidence. Two RCTs and four nonrandomized studies were identified. Data extraction was only possible for one RCT. Results showed that the number of patients with no vertigo attacks significantly increased following active treatment (relative risk 1.52; [95% confidence interval: 1.19-1.94]). The quality of evidence was rated as low. None of the nonrandomized trials included a proper control group, which hindered data extraction and quality assessment. Conclusion There are currently no RCTs that specifically assess the efficacy of VTI in patients with MD. Current limited data suggest a considerable positive effect on the number of vertiginous episodes in patients with MD. However, due to poor evidence, a fluctuating course and a substantial placebo-effect associated with MD-treatment, no solid conclusion(s) regarding the efficacy of VTI can be made. There is a need for high-quality RCTs.

Effect of Ventilation Tube Insertion on the Quality of Life / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Traditionally, the treatment results after ventilation tube insertion (VTI) in otitis media with effusion (OME) have been reported using the objective measures such as the changes in hearing levels, the recurrence rate of OME and the occurrence rate of tympanic membrane sequelae. This present study was to determine the effect of VTI on the quality of life (QOL) in patients of OME after the surgery. MATERIALS AND METHOD: Sixty-nine children with OME were included. For the measurement of QOL, the study was performed using questionnaires including six items such as physical suffering, hearing loss, speech impairment, emotional distress, activity limitations and care-provider concerns. We questioned the parents of the patiens on these items pre-operatively and at least one month after VTI. Test-retest reliability was determined by reviewing the results of the repeated questionnaires within 7 days in the subgroup of patients with stabilized status. The effect of VTI was determined by the standardized response mean (SRM), which is defined as the mean change score divided by standard deviation. SRM of less than 0.5 was defined as small effectiveness: greater than 0.5 but less than 0.8 as moderate effectiveness; greater than 0.8 as large effectiveness. RESULTS: Individual items of the questionnaire showed excellent test-retest reliability. The median of the preoperative QOL score was 4.1. The median change of the QOL scores after VTI was 2.4, with a SRM of 0.77 (95% confidence interval 0.54-0.99), indicating moderate effectiveness. The QOL scores of the items regarding hearing loss, care-provider concerns and physical suffering showed greater changes after VTI than those of other items. Among the items, those regarding speech impairment showed least change. CONCLUSION: VTI resulted in the improvement of QOL in most patients. Measurement of QOL could be a reliable test to study the effect of VTI in OME patients.

Clinical Study of Laser Myringotomy with Ventilation Tube Insertion on Pediatric Chronic Otitis Media with Effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Complications of a knife myringotomy with ventilation tube insertion is rather frequently encountered. To reduce such complications, we have performed myringotomy using a contact Nd: YAG laser. The purpose of this study was to evaluate the efficacy and safety of laser assisted myringotomy (LAM). MATERIALS AND METHODS: Sixty three patients (106 ears) of ages 1 to 7 were investigated retrospectively. Under the intravenous general anesthesia, LAM was performed to create a 2.0 mm sized perforation. After LAM, a ventilation tube was inserted. RESULTS: All ears underwent successful placement of ventilation tubes. Compared with knife myringotomies, LAM was safe to use in the atrophic tympanic membrane. There were also less intraoperative bleeding and tube plugging, with much lower postoperative otorrhea and myringosclerosis compared to knife myringotomies. Granuloma around the tube did not occurred. Postoperative improvement of air-bone gap reflects that LAM does not damage the inner ear. CONCLUSION: LAM with ventilation tube insertion is more effective than the previous knife myringotomy.

Factors That Affect the Development of Tympanosclerosis after Ventilation Tube Insertion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The tympanosclerosis is an abnormal deposits of collagen materials on the lamina propria of the tympanic membrane or the middle ear mucosa. It usually appears as a whitish plaque on the tympanic membrane through otoscopic examination. The etiology of tympanosclerosis is not known, but there are some theories that attempt to explain the pathogenesis. The aim of this study is to understand the pathogenesis of tympanosclerosis and to find out the methods to minimize the occurrence of tympanosclerosis after ventilation tube insertion. MATERIALS AND METHODS: Otoscopic examination, impedance and pure tone audiometry were performed on 190 patients (306 ears) with serous otitis media, and on those who have undertaken ventilaton tube insertion from 1990 to 1998 at the otolaryngology department in Hanyang University Hospital. Then, the patients' medical and operative records were reviewed and analyzed in view of location and pathogenesis of tympanosclerosis. RESULTS: Incidence rate of tympanosclerosis was 42.5% in non-cleft patients and 61.9% in congenital cleft and palate patients. The rate increased when larger and heavier tube was used and the middle ear fluid was highly viscous. Most common sites for the development of tympanosclerosis were in the posteroinferior and anteroinferior portions of the tympanic membrane. Tympanosclerosis had little effect on hearing but in severe cases, it caused mild degree of hearing loss. CONCLUSION: We consider that tympanosclerosis is an inevitable result of ventilation tube insertion and its pathogenesis is multifactorial. We found that we can minimize the occurrence of tympanosclerosis by using small and light ventilation tubes, and avoid intraoperative bleeding and minimal mechanical trauma on the tympanic membrane by aspiring the middle ear fluid.