History of myringotomy and grommets

Otological outcome in cleft lip and palate children with middle ear effusion

OBJECTIVE

To evaluate the factors contributing to middle ear pathology, hearing and speech development among cleft palate children treated for middle ear effusion.

METHOD

A prospective cross-sectional otoscopic and audiological analysis was conducted on 102 cleft palate children (204 ears) aged 1-18 years old who were treated for middle ear effusion at our centre. Retrospective chart review was done to determine patient characteristics and prior patient management. The aim was to assess the effect of ventilation tube insertion (VTI) on hearing, speech and chronic otitis media; comparing the timing and number of ventilation tubes per ear and determining other factors affecting the short-term and long-term outcome.

RESULTS

68 children or 130 ears (63% of all cases) were selectively treated with ventilation tube insertion. Repeat procedures (more than 2) were performed in 41 ears. Among children with VTI performed, the incidence of chronic otitis media in children after the age of 4 was 17%. Overall, abnormal tympanic membrane findings and hearing loss were detected in nearly half the cases who were previously treated with VTI. Early ventilation tube insertion at less than 1 year of age, resulted in a better middle ear and hearing outcome in children less than 4 years old (p < 0.05), however there was no significant difference in children more than 4 years old. Early surgical repair of cleft palate prior to the age of one year resulted in favourable results in both age groups (p < 0.05). There was a higher prevalence of chronic otitis media with repeated grommet insertion (3 or more) (p < 0.05). Speech and language milestones were achieved in 94% of all children above the age of four.

CONCLUSION

Treatment with early ventilation tube insertion prior to the age of one year provides a hearing benefit in children less than 4 years of age, but no significant difference after 4 years of age. Factors significantly affecting the outcome after 4 years of age was the timing of palatal closure and total number of tube insertions. We recommend a conservative approach especially when considering repeated tube insertions. A long-term follow-up paired with interval hearing assessment is advocated until early adulthood.

History of Myringotomy and Grommets: A Perpetuation of Inaccuracies?

This letter discuss the inaccuracies contained in the recent paper about history of myringotomy and grommets.

How advances in light technology have shaped ENT

The development of light technologies, allowing anatomical visualisation of otherwise hidden structures, led to significant advances in ENT in the nineteenth and twentieth centuries. Natural light from the sun, and from candles, was initially harnessed using mirrors. Later, the invention of limelight and electricity preceded the emergence of the modern-day endoscope, which, in tandem with the discovery of coherent fibre-optics in the 1950s, significantly expanded the surgical repertoire available to otolaryngologists. This study aimed to trace the rich history of ENT through the specialty's use of light.

Myringotomy and Ventilation Tube Insertion with Endoscopic or Microscopic Technique in Adults

The purpose of this study is to assess the feasibility of endoscopic-assisted myringotomy and ventilation tube insertion in adults affected by chronic otitis media with effusion, comparing the outcomes of this approach with those obtained with the traditional microscopic technique. Twenty-four patients were enrolled in this trial and alternately assigned to 2 groups of 12 subjects each. In group A, patients underwent myringotomy and ventilation tube insertion under endoscopic view, whereas in group B, the same procedure was performed traditionally using a microscope. All cases were evaluated 1 week after surgery and then monthly until tube extrusion. Type A tympanogram was achieved in 10 of 13 ears in both groups (76.92%). No significant difference in operative times or complication rates was observed ( P > .05). Endoscopic technique could be a viable alternative to the microscopic approach for myringotomy and ventilation tube positioning in adults affected by chronic otitis media with effusion.

Transmyringeal ventilation tube treatment in children: hearing outcome after 10 years

OBJECTIVE

This ten-year cohort study intended to determine any hearing impairment and eardrum sequelae comparing children treated with ventilation tubes (VT) with an age- and gender-matched control group.

METHODS

A cohort of children who received ventilation tubes in 1996 was during 2006 compared with a control group, with no history of VT treatment, using standard audiometry, high frequency audiometry and otomicroscopy.

RESULTS

In the spectrum of the standard audiometry, the differences between the groups were minimal. In the high frequency spectrum, even in a subgroup with normal eardrums, there were significant and major differences with inferior hearing thresholds in treated ears compared with the ears of the control group. The ventilation tube treated group presented a higher prevalence of eardrum pathology.

CONCLUSION

The ears treated with ventilation tubes had significantly higher hearing levels than the control group in the high frequency spectrum. This could be caused by the history of middle ear disease, the VT treatment or both combined.

CPCJ 50th Anniversary Editorial Board Commentary: Otolaryngology--then and now

This review continues the series of articles by the Editorial Board reflecting upon the first volume of the journal published in 1964 and celebrating the 50th anniversary of The Cleft Palate-Craniofacial Journal. This editorial examines the contributions of Otolaryngology-Head and Neck Surgery to interdisciplinary cleft care. The aerodigestive tract has many functions that are impacted by the cleft anomaly. Progress in the development of selected therapies will be reviewed.

Never trust secondary references: examples from the early history of myringotomy and grommets

The regular use of secondary references is associated with many inaccuracies. The aim of this study is to demonstrate this fact through examples extracted from recent papers mentioning the early history of myringotomy and grommets. These inaccuracies are in relation with the lack of control of the original references dealing with the subject. In conclusion, never believe and use secondary references as primary sources, without reading the original paper to confirm that it says what you think it does, but take them only for preparing and discussing the studied subject.