Middle Ear Ventilation Tube Insertion Research Articles

Clinical Factors Associated With the Outcomes of Long-Term Middle Ear Ventilation Tube Insertion in Pediatric Patients.

Ventilation tube (VT) insertion is the most common treatment for otitis media with effusion (OME). However, OME recurrence and persistent tympanic membrane (TM) perforation after VT removal are encountered in a certain percentage of such children. This study was performed to determine the outcomes of children who underwent long-term VT insertion. A total of 326 ears from 192 patients were analyzed. The associations among the patient age, sex, history of OME, history of repeated acute otitis media, placement duration, whether the VT had been removed intentionally or spontaneously, and the outcome (persistent TM perforation or OME recurrence) were analyzed. The outcomes of multiple VT tube insertions were also reviewed. We also analyzed whether or not local or general anesthesia was associated with the early spontaneous extrusion of the VT. The OME recurrence and TM perforation rates were 29% (96/326 sides) and 17% (57/326 sides), respectively, for first insertions. In addition, 96 (29%) sides underwent ≥2 insertions. The shorter the duration for which the VT was retained in the middle ear, the more significant the rate of increase in OME recurrence. The OME recurrence was observed more often when VT was spontaneously removed than when intentionally removed. The rate of persistent TM perforation was significantly associated with male sex. Persistent TM perforation was not observed in patients who underwent 4 or 5 insertions. The anesthesia method did not significantly influence the timing of spontaneous extrusion of VT. The retention period of VT should be at least 2 years, and VT removal at the age of 7 might be a viable strategy. Multiple VT insertions are recommended for patients with recurrent OME. Ventilation tube under local anesthesia is an effective option for tolerable children.

Middle Ear Ventilation Tube in Patients with Cleft Palate at King Abdulaziz University Hospital

This study aims to determine the number of patients with cleft palate requiring treatment for otitis media with effusion. Speech and hearing assessments were also considered. We conducted a retrospective study from January, 2005 through December, 2012 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, on otitis media with effusion in patients with cleft palate. We reviewed patients’ medical records to determine the number requiring treatment for otitis media with effusion, the timing of middle ear ventilation tube insertion, the number of tubes to be inserted, and the type of tube to be used. Data were collected from the patients’ medical records. Ethical approval was obtained by the university’s ethical committee. A total of 101 patients were diagnosed with cleft palate spectrum. Among them, we found that only 12 patients had a hearing assessment and tympanograms performed followed by middle ear ventilation tube insertion. This may indicate the need for more involvement of the otolaryngologists in the multidisciplinary clinical teams for evaluating cleft palate patients.

The impact of ventilation tubes in otitis media on the risk of cholesteatoma on a national level

ObjectiveTo estimate the impact of treatment with middle ear ventilation tube insertion (VTI) in children with otitis media (OM) on the risk of cholesteatoma on a national level. MethodsData were obtained from the Danish National Patient Register, the National Health Service Register and Statistics Denmark. Cumulative incidence proportions were estimated by the Kaplan–Meier method and hazard ratios with Cox regression analysis. The first surgically treated middle ear cholesteatoma in a child (STMEC1) was considered an event. ResultsA total of 217,206 children, born after December 31, 1996, who had VTI from January 1, 1997 to August 31, 2011 were identified. Of these, 374 subsequently had a STMEC1.A corresponding 36,981 children without any VTI were identified for comparison using a random 5% sample of the Danish population. Of these, 5 had a STMEC1.The cumulative incidence proportion with STMEC1 at 12 years of age for children with 0, 1, 2, 3, and ≥4 VTI's was 0.04% (95% confidence interval 0.02–0.12%), 0.21% (0.18–0.26%), 0.35% (0.28–0.43%), 0.40% (0.30–0.54%), and 0.55% (0.44–0.70%), respectively.In the regression model each additional year of age before the first VTI increased the risk of STMEC1 by 54% (47–63%), while each additional year between two successive tube insertions increased the risk by 28% (15–43%). ConclusionWe found that prolonged OM requiring multiple VTIs was associated with an increased risk of STMEC1. Early age at first VTI and short time between two VTIs was associated with a lower risk of STMEC1. This may be the result of reduced time with negative middle ear pressure and OM. However, these findings may be susceptible to selection bias, as age at first VTI and time between VTIs, as well as the outcome variable, STMEC1, may all depend on the underlying indication for VTI.In short the present study suggests that treatment with VTI in children with OM reduces the risk of STMEC1 on a population level. However, for the individual child the absolute risk reduction is very small, and the decision of treatment with VTI must always rely on the symptoms and clinical findings in the individual child.

Cholesteatoma in Danish children – A national study of changes in the incidence rate over 34 years

ObjectiveTo describe temporal trends in the incidence rate of surgically treated middle ear cholesteatoma in Danish children from 1977 to 2010. MethodsData on surgically treated middle ear cholesteatoma was drawn from the Danish National Patient Register.A change in incidence rate over time was examined using Poisson regression analysis, while the cumulative incidence proportion was estimated using life-tables. ResultsA total of 5850 cases of surgically treated middle ear cholesteatoma distributed among 3874 children aged 0–15 years were identified.From 1977 to 2002 the age-standardized incidence rates for first-time surgically treated middle ear cholesteatoma increased from 8 to 15 per 100,000 person-years with an estimated annual increase of 1.8% (95% confidence interval (CI) 1.3–2.2%).From 2002 to 2010 the rates decreased from 15 to 10 per 100,000 person-years with an annual decrease of 5.4% (95% CI 3.2–7.5%).Age-specific incidence rates were at maximum around the age of 9 years during the whole period.The estimated cumulative incidence proportion at age 16 years based on the 2010 age-specific incidence rates was 0.16% (95% CI 0.09–0.32%) compared with 0.20% (95% CI 0.11–0.37%) based on the 2000 age-specific incidence rates. ConclusionFrom 2002 to 2010 there was a decrease in the incidence rate of first-time surgically treated middle ear cholesteatoma. The decrease was preceded by a significant increase in the incidence rate of middle ear ventilation tube insertion. However, further studies are needed to find possible explanations for the decrease.

PO-0915 Therapeutic Options For Conductive Hearing Loss In Children With Cleft Palate

Background and aim Cleft lip and palate is a common congenital malformation correlated with otological disorders like Eustachian tube dysfunction, otitis media with effusion and conductive hearing loss correlated with speech disorders. Methods In our study we evaluate the therapeutic options for the conductive hearing loss in these children, such as: middle ear ventilation tube insertion, hearing aids and adenoidectomy. We conducted a retrospective chart review on 19 patients who underwent last follow-up during 2013, aged between 1 and 16, affected by cleft palate. We identified 3 cases of Treacher-Collins syndrome, 2 cases of CHARGE syndrome, 2 case sof Pierre Robin, 1 case of Goldhenar and 1 case of Di George syndrome. In 9 cases the cleft palate was isolated. In 14 cases we conducted phoniatric and logopaedic evaluations and 10 of these showed a speech disorder. Results We found a conductive hearing loss in 12 of the 19 children.2 of these patients used hearing aids with an improvementof speech performance; 1 patient underwent adenoidectomy for the appearance of sleep apnea but he modified his quality of voice with hypernasality and nasal emission after surgery; finally 9 children had spontaneous resolution of otitis media with effusion. Conclusions In conclusion we found that the more effective way to resolve the problem of conductive hearing loss and the resulting speech disorder is to use the hearing aids until the resolution of the hearing loss, which normally occurs around 7 years old.

Increasing rate of middle ear ventilation tube insertion in children in denmark

ObjectiveTo study the incidence rates of middle ear ventilation tube insertion in children aged 0 to 15 years in Denmark from 1997 to 2010. MethodsUsing two national registers, the Danish National Health Service Register and the Danish National Patient Register, practically all cases of middle ear ventilation tube insertion performed in Denmark in the period were identified. A possible change in incidence rate over time was examined using Poisson regression analysis, while the cumulative incidence proportion was estimated using life-tables. ResultsA total of 502,569 uni- or bilateral ventilation tube insertions distributed among 269,459 different children were identified. From 1997 to 2010 the age standardized incidence rate in 0–15-year-olds increased from 26 to 40 per 1000 person years with an estimated annual increase of 2.0% (95% confidence interval 1.9–2.1%). The largest increase in incidence rate was found in 1-year-olds with an annual increase of 4.5% (95% confidence interval 4.4–4.6%). Age-specific incidence rates remained at maximum around the age of 14 months throughout the period. The cumulative incidence proportion for the 2010 birth cohort by the time they reach the age of 5 years was estimated to 29% (95% confidence interval 28–29%). ConclusionThe rate for middle ear ventilation tube insertion in Denmark was high compared to other developed countries, and an estimated 3 in 10 children born in 2010 will undergo at least one ventilation tube insertion before their fifth birthday.

Cholesteatoma in cleft lip and palate: A population‐based follow‐up study of children after ventilation tubes

To investigate the association of cleft conditions and the development of secondary cholesteatoma following middle ear ventilation tube insertion (MEVTI) in children. A retrospective cohort study of all children born after 1980 who underwent at least one MEVTI in a Western Australian hospital from 1980 to 2009 using administrative health data. The timing and number of MEVTIs, adenoidectomy, type of cleft conditions and cholesteatoma were identified along with demographic variables. Flexible parametric proportional hazards models and hazard functions using age as a time scale were used to estimate the relative rate of developing cholesteatoma. There were 56,949 children who underwent at least one MEVTI during the study period. There were 869 (1.5%) children who also had a diagnosis of a cleft condition. Overall, 594 (1.0%) children developed a secondary cholesteatoma. After taking length of follow-up into account, 6.9% (95% confidence interval [CI], 5.0-9.6) of children with cleft conditions developed cholesteatoma by 18 years of age compared to 1.5% (95% CI, 1.3-1.6) of children without cleft conditions. After adjusting for demographic and clinical variables, children with cleft conditions developed cholesteatoma 7.5 (95% CI, 3.8-18.2) times faster after first MEVTI compared to children without cleft conditions, although by the third MEVTI this difference was no longer statistically significant (P = .257). The rate of developing cholesteatoma in 2005 to 2009 was 0.5 (95% CI, 0.3-0.8) times that of 1980 to 1990. Children with cleft conditions are at increased risk of developing cholesteatoma compared to other children who had one or two MEVTIs, although the overall rate of cholesteatoma is declining.

The Effect of Ketamine with Remifentanil for Improving the Quality of Anaesthesia and Recovery in Paediatric Patients Undergoing Middle-Ear Ventilation Tube Insertion

This prospective randomized study evaluated the effects of ketamine with remifentanil to improve the quality of anaesthesia and postoperative recovery, following brief procedures, in 60 paediatric patients undergoing middle-ear ventilation tube insertion (MEVTI). Patients were randomly assigned to either ketamine 2 mg/kg intravenous [i.v.] bolus plus normal saline by i.v. infusion (K group, n = 30) or ketamine 2 mg/kg i.v. bolus, plus remifentanil 0.15 μg/kg per min i.v. infusion (KR group, n = 30). Parameters that were assessed included intraoperative patient movement, surgeon satisfaction, anaesthesia time, total ketamine dose, postoperative recovery time, agitation and side-effects. Intraoperative patient movement scores were significantly lower, and surgeon satisfaction scores were significantly higher, in the KR group than in the K group. Time to recovery was significantly shorter in the KR group than in the K group. In conclusion, remifentanil was a good adjuvant to ketamine, improving the quality of anaesthesia and postoperative recovery in children undergoing MEVTI.

중이내 환기관 삽입술과 후두미세수술에서의 통원수술과 입원수술의 만족도 비교

Background: This study was designed to compare the patient’s satisfaction between ambulatory surgery and inpatient surgery in otolaryngology department. Methods: The data was gathered from 52 pediatric patients who underwent middle ear ventilation tube insertion and 52 adult patients who underwent laryngeal microsurgery in the otolaryngology department between January in 2006 and April in 2009 through telephone survey. Contents of the questionnaire were consisted of the follwoing 7 categories: satisfactory level of time consuming, medical cost, postoperative pain, burden of family, explanation of medical personnel, hospital environment and recommendation of surgery in the same way. Results: It was appeared that both groups of the patients were generally satisfied no all the 7 categories. Satisfactory levels of time consuming and medical cost in the ambulatory surgery group were higher than the inpatient surgery group in both adult and pediatric patients. In the inpatient surgery group, satisfactory levels of postoperative pain and explanation of medical personnel were higher than the ambulatory surgery group in both adult and pediatric patients. Satisfactory level of hospital environment in the inpatient surgery group was higher than ambulatory surgery group only in the pediatric patients. Conclusions: Ambulatory surgery should be more widely implemented, because it has higher economic effi-ciency and patient’s satisfaction level of time consuming and medical cost. However, in ambulatory surgery, patients and caregivers will need more specific education than in inpatient surgery. Active pain control and improvement of hospital environment will be also required. (J Clinical Otolaryngol 2009;20:194–200)

Follow up after middle-ear ventilation tube insertion: what is needed and when?

Follow up after middle-ear ventilation tube insertion: what is needed and when?

Clinical Analysis of Outpatient Anesthesia in Children with Middle Ear Ventilation Tube Insertion

Background: Pediatric outpatient anesthesia is beneficial because it is more comfortable to children and more convenient for families, but delayed discharge causes distress for parents and children and increases health care personnel workload. Therefore, we examined past medical records to evaluate factors affecting discharge time in pediatric outpatient anesthesia. Methods: We reviewed the anesthetic and post-anesthetic care records of 119 children who required ventilation tube insertion for ambulatory surgery, and who were anesthetized and monitored by an anesthesiologist between June 2001 and February 2004. Data were classified according to the anesthetic technique and agents used, duration of operation and anesthesia, and complications in the recovery room. We then examined the relationships between these factors and discharge time. Results: Compared to intravenous anesthesia, endotracheal anesthesia increased anesthesia time (P