Long-Term Results of Tympanostomy Treatment In Chronic Secretory Otitis Media

Mean hearing thresholds among school children in Taiwan

OBJECTIVES

The primary aim of this study was to obtain the mean hearing thresholds among school-age children residing in the Datong and Jhongshan Districts of Taipei City, Taiwan.

DESIGN

Hearing thresholds were obtained from a stratified sample of 1411 students in grades 1, 4, 7, and 10 based on their participation in the annual health examination of school-age children carried out by the Taipei City Government. After otoscopic examination, audiometric testing was undertaken at 0.5 to 4 kHz along with tympanometric screening. The means and SDs obtained from these examinations are reported by grade, gender, ear, and frequency.

RESULTS

The mean hearing thresholds ranged between 6.8 and 16.7 dB HL, with the highest (poorest) hearing threshold being obtained at a test frequency of 0.5 kHz. At all the tested frequencies, the hearing thresholds of boys were found to be higher than those of girls. Logistic regressions demonstrating that those students with the highest odds ratios of hearing loss were to be found in the sample of children in grade 1. The odds ratios of hearing loss were also found to be higher among boys than girls and for the left ear rather than the right.

CONCLUSIONS

These results indicate that the mean thresholds among the study sample were well above (meaning poorer) the pure-tone average of 15 dB HL, as recommended in a previous study. Therefore, the results of this study suggest the need to further determine the etiology of hearing loss among children in grades 1, 4, 7, and 10 in the Datong and Jhongshan Districts of Taipei City and perhaps Taiwan.

Otological and audiological outcomes five years after tympanostomy in early childhood

OBJECTIVE

Ventilation tubes in the treatment of otitis media in young children remain controversial. Despite abundant research, few prospective long-term follow-up studies have included even a minority of patients under 1 year old. We investigated long-term otological and audiological outcomes in children with recurrent acute otitis media and otitis media with effusion, who were treated early with ventilation tubes.

STUDY DESIGN

Prospective follow-up.

METHODS

Three hundred five children under 17 months of age received a primary tympanostomy in the Central Hospital of Central Finland (Jyväskylä, Finland), and those 281 (92.1%) who were monitored prospectively for 5 years made up the study group. At the final examination, pneumatic otoscope and otomicroscope were used and pure-tone audiometric thresholds of air and bone conduction were measured to define the hearing levels (mean of 0.5, 1.0, and 2.0 KHz thresholds).

RESULTS

Of ears, 67.3% were healed, 7.1% had a retraction of tympanic membrane in pars flaccida and 9.6% in pars tensa, 7.5% had an ongoing otitis media with effusion, 3.9% had a ventilation tube in place, and 4.6% had a tympanic membrane perforation with mean hearing levels of 7.6, 9.0, 16.0, 18.5, 10.5, and 17.7 dB, respectively.

CONCLUSIONS

Hearing in general was well preserved, and no ear presented with adhesive otitis media or cholesteatoma. Adverse otological and audiological outcomes of these young children did not exceed those presented by others for older counterparts. Tympanic membrane perforations, ongoing otitis media with effusion, and pars tensa retractions were causes of mild conductive hearing loss. Because one third of ears continued to have middle ear disease or sequelae, we emphasize the proper follow-up and restoration of middle ear ventilation with repeat ventilation tubes if not otherwise achieved.

Tympanostomy in young children with recurrent otitis media. A long-term follow-up study

A total of 305 children, five to 16 months of age, were treated from 1983-1984 with ventilation tubes-Shah vent Teflon tube-inserted under local anaesthesia for recurrent acute otitis media (RAOM) or otitis media with effusion (OME). The final study group comprised 281 children (92.1 per cent) monitored prospectively for five years, 185 in the OME-group and 96 in the RAOM-group. For the first insertion of tubes the average ventilation period was 15.4 months. Re-tympanostomy, with adenoidectomy simultaneously at the first time was performed in 99 ears (35.2 per cent); once in 27.0 per cent, twice in five per cent, and three times in 3.2 per cent. Mastoidectomy due to otorrhoea was performed in three ears (1.1 per cent). The children in the OME-group were at higher risk of repeated post-tympanostomy otorrhoea episodes than children in the RAOM-group. These episodes of otorrhoea during the first insertion of ventilation tubes significantly increased both the tube extrusion rate and the need for subsequent re-tympanostomies. No major complications were caused by the tympanostomy procedure as such. It is concluded that early tympanostomy is a safe procedure in young children with RAOM or OME. However, parents should be carefully informed of risks of post-tympanostomy otorrhoea and recurrent disease after insertion of ventilation tubes necessitating subsequent tube insertion, especially in children with OME.

The hearing threshold levels of children at school age

OBJECTIVE

To measure the hearing threshold levels by air conduction in a group of unselected and a group of selected (otologically normal) school-aged children.

DESIGN

Six hundred eighty-seven unselected school children representing three age groups and 471 selected, otologically normal children were examined by pure-tone audiometry.

RESULTS

The obtained results showed that hearing levels improved with age from 7 to 10 yr in children in both groups. The pure-tone averages (PTAs) of the right and the left ear in otologically normal children were, respectively, 1.8 and 1.2 dB HL in 7-yr-old children, -0.9 and -1.7 dB HL in 10-yr-old children, and -1.3 and -2.0 dB HL in 14-yr-old children. The PTAs were 0.2 to 1.9 dB poorer in the groups of unselected children.

CONCLUSIONS

The present study provides new data on the hearing sensitivity among unselected 7-, 10-, and 14-yr-old school children. Furthermore, it provides normative values on the hearing thresholds of otologically normal children in these three age groups.

Comparison of the repair of permanent tympanic membrane perforations by hydrocolloidal dressing and paper patch

Thirty consecutive patients with permanent perforations of their tympanic membranes (TM) present from 2.5 to 50 years (mean 18.7 years) were admitted to a prospective study using two alternative methods of dressings for closure of the perforations. An adhesive-coated hydrocolloid material was compared with a conventional dressing of vaseline impregnated rice paper patch after de-epithelialization of the perforation border. Nine of the permanent TM perforations (30 per cent), five with the hydrocolloidal dressing and four with the rice paper patch had healed when followed-up after one year. The size of eight of the central perforations that had healed was equal to or less than 25 per cent of the TM. Also one perforation with a size of 65 per cent had healed. Seven perforations were located in the posterior part of the TM: four in the posterior-superior quadrant, one in the inferior quadrant, one had engulfed the posterior half of the TM and one included the anterior-inferior quadrant. Only two perforations out of 14, with a size of 25 per cent or less, located in the anterior-inferior quadrant, healed. No significant difference was demonstrated between the two types of dressings. Both groups noted an immediate improvement in hearing of 10.8 and 9.3 dB, respectively, after application of the dressing. The study demonstrates that application of an occlusive dressing or paper patch in 30 per cent of patients can promote the healing of long-standing perforations. The chances for healing are better if the perforation is located in the posterior part of the TM. This simple technique immediately improved hearing and should be tried before a patient is referred for myringoplasty surgery.

Influence of tympanic membrane changes on audiometric and immittance findings in school-aged children

Six-hundred-and-eighty-seven 6 to 15-year-old children were examined for the association between tympanic membrane (TM) changes and audiometric or immittance findings. The hearing thresholds were between 20 and 30 dB in ears with amber TM, but between 25 and 45 dB in ears with adhesive TM. When the TM was retracted or the mobility decreased, the hearing thresholds were about 10 dB poorer than in ears with normal TM position or mobility. Thick TM caused hearing loss in the high-frequency areas. The hearing loss was only marginal (3-4 dB) in ears with retracted pars flaccida compared with ears with normal position of pars flaccida. The mean and median middle ear pressure value was lower than -200 da Pa in ears with dull, amber, retracted, poorly movable, adhesive or thick TM. It was between -100 and -200 da Pa in ears with red TM, locally retracted pars tensa or retracted pars flaccida. Stapedius reflex thresholds were higher in ears with one or several abnormal findings than in normal ears.

Late results of treatment with ventilation tubes for secretory otitis media in ENT practice

Ventilation tubes were inserted in 262 children aged 0-9 years for secretory otitis media in the period 1975-78. Treatment according to earlier described procedures during the intubation period, including a final check 3 months and 1 year after extrusion, were done. If recurrences were observed, retubulation was performed. 191 patients (73% (355 ears] have been re-evaluated in February, 1986, to February, 1987, mean observation period 7 1/2 years. Clinical information was obtained. Otomicroscopy, including pneumatic otoscopy, impedance and pure-tone audiometry, has been carried out. Flaccida retractions of varying degree were present in 21% of the ears. Atrophic scars were present in 28%; no case of complete atelectasis was found. Perforations were seen in 2%. Myringosclerosis was seen in 48%. No cholesteatoma or meningitis was found or reported in the entire material. 99% had a pure-tone average (500, 1,000, and 2,000 Hz) of 20 dB-HL or less (5 dB, 60%). Treatment with a ventilation tube seems to give the least complications when installed early in life. The importance of careful follow-up is emphasized. We recommend otomicroscopy at each control check, especially 3 months and 1 year after extrusion.

Finnish approach to the treatment of acute otitis media. Report of the Finnish Consensus Conference

The theme of the first consensus conference to be held in Finland was the treatment of acute otitis media. The statements and recommendations accepted by the conference, which was organized according to the National Institutes of Health model, are presented in this report. On the basis of scientific knowledge, clinical experience, and conditions in Finland, the conference delegates concluded that penicillin V, in large doses, is still the drug of first choice in this disease. The importance of surgical drainage of the middle ear was stressed, as was the necessity of careful follow-up of the patient until the condition is completely healed. Decongestants were considered rather useless. In the prevention of recurrent attacks, adenoidectomy but not tonsillectomy was regarded as being of help, tympanostomy of probable benefit, antimicrobial (sulfonamide) prophylaxis worth considering in selected cases, but the effect of pneumococcal vaccination poor. The conference delegates agreed that uncomplicated acute otitis media should, as before, usually be treated by physicians taking care of children at the primary health care level.