Pediatric Otitis Media with Effusion: A Comparative Study of Effective Treatment

Abstract

Introduction: Otitis media with effusion (OME) is one of the most common diagnoses in children. Adenoidectomy +/- Myringotomy +/- Tympanostomy tubes are daily procedures in our practice to treat such condition. Objectives: Primary aim: to examine efficacy of different surgical treatment modalities in different pediatric age groups, secondary aim: to see whether patient’s age can be considered as a predicting factor affecting surgical option selection, and to compare rate of tubes reinsertion in different surgical modalities. Methods: Retrospective, cross-sectional analysis of consecutive children with otitis media with effusion (OME), had As +/- M +/- TT, from May, 2010 till August, 2013. By using electronic database and patient’s charts, all patients younger than 18 years of age and had a minimal follow up of 12 months were included in our study. We excluded children with acute recurrent or adhesive OM, and cholesteatoma. Collected Data includes demographics, symptoms at presentation, age at initial and repeated MTT, and duration till tubes extruded. Results: Total 303 cases included. Three groups identified based on performed surgery. 50.2% of children had As + MTT, those were children average 7.7 years of age, and they were younger than the group that had MTT alone by two years (p-value = 6.097x10-5), and had TT reinsertion rate of 15%. In comparison, MTT group had a reinsertion rate was 18.2%, and As + M with no tubes cases were average of 5.7 years of age at time of first procedure, and were younger than those who had M alone by almost 5 years (p-value = 5.535x10-17). As + M group had the highest recurrence rate among all studies group (22%). In all the groups and regardless of the surgical modalities, reinsertion rate was related to early tubes extrusion. Conclusion: This is the first and only study carried out in Arabian Peninsula, addressed efficacy of different surgical procedures in treatment of OME, and highlights the possibility of utilizing patient’s age at presentation as predicting for the most effective surgical options selected. When taking into consideration known risk factors, reoperation can be avoided in some cases.