Bilateral Myringotomy Tube Research Articles

Effusion Prevalence at Tympanostomy During COVID-19: Follow-Up.

We previously reported pandemic year (2020) intraoperative middle ear effusion (MEE) rate at time of bilateral myringotomy tube (BMT) placement was 18% lower compared to pre-pandemic year (2019). After mandatory stay at home orders (MSHO) and pandemic social distancing precautions were relaxed, we aimed to assess the impact of a persistent pandemic with new COVID-19 variants on MEE presence during BMT. This study is a retrospective chart summary exempted by Nemours institutional review board at a single tertiary children's hospital. Children < 18years who underwent BMT during March 1, 2019-June 31, 2019 (pre-COVID), March 1, 2020-June 31, 2020 (PY1), and March 1, 2021-June 31, 2021 (PY2) were included. Statistical analysis included chi-squared and KruskalWallis. A total of 1069 BMTs were reviewed: 551 (52%) during pre-COVID, 227 (21%) during PY1, and 291 (27%) during PY2. There were no significant differences in age, sex, or BMI across comparison groups. Intraoperative MEE was significantly higher pre-COVID (83%) compared to PY1 (65%) and PY2 (69%) (P < .001) despite a small rebound in PY2. Intraoperative MEE remains lower in subsequent pandemic years despite relaxed public health measures and may be impacted by persistent public health measures like masking, lower return to daycare, variable social distancing, and/or change to access to health care.

Association between symptomatic submucous cleft palate and otologic disease: A retrospective review

IntroductionSubmucous cleft palate (SMCP) is the most common congenital malformation of the posterior palate and characterized in part by palatal muscle diastasis. Patients with SMCP are considered symptomatic when suffering from velopharyngeal insufficiency which leads to hypernasality of speech and excess nasal air emission. SMCP results from defects in the muscles thought to be responsible for regulating the patency of the eustachian tube which can lead to a number of middle ear pathologies and ultimately hearing loss. Hearing loss, especially at a young age, can make speech acquisition a challenge. The purpose of this study was to review patients with symptomatic SMCP (SSMCP) who have presented to our center and report on the association between SSMCP and otologic disease. MethodsThis study was a retrospective review of all patients presenting to our center between 2004 and 2016. Patients with SSMCP were identified through a patient database maintained on site. Inclusion criteria were diagnosis of SMCP and documentation of the presence or absence of otologic disease. Once identified patient records were reviewed and various demographic and patient factors were recorded. Patients were then grouped into cohorts of those with and without otologic disease and those requiring tympanostomy tubes and not. T-tests were then used to compare various factors between cohorts. ResultsA total of 73 patients were identified and 58 met inclusion criteria (mean age 5.8 years, male:female 36:22). 27.5% of patients were diagnosed with a genetic condition. 69% of patients had otologic disease and 47% required at least one set of bilateral tympanostomy myringotomy tubes. The cohort with ear disease tended to have worse scores on ACPA testing though this was not statistically significant. There were no significant demographic differences between the cohorts. ConclusionsPatients with symptomatic SMCP suffer from a higher incidence of otologic disease and bilateral myringotomy tube placement than the general population. This is an important potential comorbidity in SSMCP patients as it can act as a further barrier to speech acquisition. Further research is needed to determine if otologic disease can be used for prognostication or treatment purposes.

Acupuncture management of pain and emergence agitation in children after bilateral myringotomy and tympanostomy tube insertion

To further investigate the effect of acupuncture in postoperative pain and emergence agitation in children undergoing bilateral myringotomy and tympanostomy tube (BMT) placement. BMT insertion surgery in children is routinely performed under general anesthesia and is associated with a high incidence of postoperative pain and agitation upon emergence from anesthesia. Various medications have been investigated to alleviate the pain and agitation, which have been accompanied by high incidence of adverse effects. In children, anecdotal reports suggest that acupuncture may offer postoperative analgesia. This prospective randomized controlled trial is to evaluate the effectiveness of acupuncture to control pain and agitation after initial bilateral myringotomy tube placement in 60 nonpremedicated children. Acupuncture was applied at points LI-4 (he gu) and HT-7 (shen men) immediately after induction of anesthesia. A single-blinded assessor evaluated postoperative pain and agitation using CHEOPS and emergence agitation scale. Pain and agitation scores were significantly lower in the acupuncture group compared to those in the control group at the time of arrival in the post anesthesia care unit and during the subsequent 30 min. Acupuncture treatment provided significant benefit in pain and agitation reduction. The median time to first postoperative analgesic (acetaminophen) administration was significantly shorter in the control group. The number of patients who required analgesia was considerably fewer in the acupuncture group than that in the control. No adverse effects related to acupuncture treatment were observed. Our study suggests that acupuncture therapy may be effective in diminishing both pain and emergence agitation in children after BMT insertion without adverse effects.

A 3-Year-Old Girl with Intermittent Fever and Abdominal Pain

&lt;P&gt;This previously healthy 3-year-old girl was admitted following a 3-month history of intermittent fever and abdominal pain. She initially had a 2-week history of intermittent vomiting and fever without diarrhea. Although this resolved, she continued to have 2 weeks of intermittent periumbilical abdominal pain and fever on a daily basis. After 2 weeks, she developed 3 weeks of watery, non-bloody diarrhea with continued intermittent fever. She had been treated with multiple doses of acetaminophen during her illness. She was seen during this time period in several emergency rooms. Over the course of the illness, she had lost 5 pounds. Birth history was unremarkable. The family history was only remarkable because her mother had had a recent illness, which had consisted of vomiting, fever, and diarrhea. Her past medical history was significant for recurrent episodes of otitis media with bilateral myringotomy tube placement at 1 year of age. At home, there is one dog, one old cat, and four kittens. Her mother is a food handler. Evaluation at an outside hospital included normal electrolytes, ALT 116 IU/mL, albumin 3.1 mg/dL, and negative stool culture, rotavirus antigen test, and stool examination for parasites.&lt;/P&gt;&lt;H4&gt;Key Learning Points&lt;/H4&gt;&lt;OL&gt;&lt;LI&gt;Ten percent to 15% of healthy school-age children have functional chronic abdominal pain.&lt;/LI&gt;&lt;LI&gt;Ultrasonography is the best initial test for imaging the biliary tract.&lt;/LI&gt;&lt;LI&gt;Choledochal cysts can be several centimeters in diameter and are sometimes palpable. There’s generally no liver dysfunction until the biliary tract obstruction becomes complete.&lt;/LI&gt;&lt;LI&gt;Asymptomatic small-bowel intussusceptions are seen regularly on computerized tomography scans. They are evanescent, and don’t cause obstruction. No treatment is necessary unless they persist and lead to a small bowel obstruction.&lt;/LI&gt;&lt;LI&gt;The likelihood of lead poisoning is higher in children who ingest coins or other foreign objects.&lt;/LI&gt;&lt;/OL&gt;&lt;H4&gt;ABOUT THE AUTHOR&lt;/H4&gt;&lt;P&gt;Dr. Listernick is Professor of Pediatrics at Feinberg School of Medicine, Northwestern University, and Director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL&lt;/P&gt;

The Effect of Intranasal Fentanyl on the Emergence Characteristics After Sevoflurane Anesthesia in Children Undergoing Surgery for Bilateral Myringotomy Tube Placement

The Effect of Intranasal Fentanyl on the Emergence Characteristics After Sevoflurane Anesthesia in Children Undergoing Surgery for Bilateral Myringotomy Tube Placement

Myringotomy Tube Placement--Another Role for EMLA Registered Trademark Cream?

To the Editor: Bilateral myringotomy tube placement is a common procedure easily performed under general anesthesia in the pediatric population. With the widespread availability and use of the topical anesthetic mixture EMLA Registered Trademark cream, this procedure has proven feasible in many children without the risks and costs of general anesthesia [1]. During a recent deployment to Honduras, tympanocentesis was performed on a total of 68 Honduran children between the ages of 8 mo and 12 yr with an otoscopic diagnosis of serous otitis. Twelve children initially undergoing tympanocentesis received a combination of halothane general anesthesia and topical EMLA Registered Trademark cream with a noticeable marked reduction in hemodynamic response to myringotomy. EMLA Registered Trademark cream was applied to the tympanic membrane with a cotton tipped swab to the following 56 children and tympanocentesis was performed 30-40 min thereafter. This was performed with a minimum of perceived discomfort or irritability in most cases. Two of the children receiving EMLA Registered Trademark cream required further mild oral sedation. Although there may be cultural differences in perception and tolerance of pain, our limited experience suggests that this anesthetic approach deserves further consideration. Also, preliminary experience suggests that prilocaine and lidocaine are not toxic to the auditory nerve [2]. Brion J. Beerle, MD Moises Arriaga, MD Wilford Hall Medical Center Lackland AFB, TX 78236