Surgical Management Of Otitis Media Research Articles

Quality of Patient Education Sections on Otitis Media Across Different Website Platforms.

To determine the quality, content, and readability of patient education materials pertaining to otitis media across several popular online platforms focused on otolaryngology and pediatric primary care education. Online patient materials related to otitis media and directed toward parents were collected from the American Association for Family Practice (AAFP), ENT-Health section of the American Academy of Otolaryngology-Head and Neck Surgery, Healthychildren.org from the American Academy of Pediatrics, KidsHealth from Nemours, WebMD, and Wikipedia. Materials were analyzed for quality, content, and readability. The DISCERN instrument was used to score quality. A unique content score was generated based on the information provided on each website and on the medical and surgical management of otitis media. Readability scores were calculated using the Flesch-Kincaid Grade Level, Flesch Reading Ease Score, Gunning-Fog Index, Simple Measure of Gobbledygook, Coleman-Liau Index, and Automated Readability Index. Overall, content was well-balanced. Information from AAFP and Healthychildren.org was focused more on medical management than other sources. The average DISCERN scores showed all sources to be of good quality with minimal shortcomings. The AAFP and KidsHealth websites had some readability scores around the 8th-grade reading level, the National Institute of Health's upper limit recommended for public health information; however, most websites were above this recommended reading level. Patient education materials related to otitis media on academic and certain popular internet sites are good sources to obtain high-quality information on the topic. Patient educational background, prior knowledge and understanding of otitis media, and physician-patient partnership goals should be taken into account when referring patients to online materials.

Do demographic disparities exist in the diagnosis and surgical management of otitis media?

Determine if demographic disparities exist between the diagnosis of otitis media (OM) and the provision of myringotomy and tubes in children. Cross-sectional analysis of a national database. The National Ambulatory Medical Care Survey 2010 and the National Hospital Ambulatory Medical Care Survey-Ambulatory Surgery 2010 were abstracted for cases with a diagnosis of OM and myringotomy and tube (MT) procedures in children, respectively. Sex, race, ethnic, and insurance distributions were computed for OM and MT and then compared for healthcare disparities between rates of OM diagnoses and MT procedures. A total of 13.6 million ambulatory pediatric OM diagnoses were identified in 2010 (55.9% male; 82.4% white, 11.3% black, and 6.3% other; 14.3% Hispanic, 85.7% non-Hispanic). A total of 413 thousand ambulatory myringotomy procedures were identified (59.6% male; 86.0% white, 11.0% black, and 3.0% other; 13.0% Hispanic, 87.0% non-Hispanic). There was no statistically significant difference in the provision of MT versus OM diagnosis according to sex (P = 0.400), race (P = 0.313), or ethnicity (P = 0.228). There was also no statistically significant difference in the percentage of Medicaid coverage for OM children (37.0%) versus those undergoing MT (31.1%; P = 0.376). There does, however, appear to be a statistically higher percentage of non-Hispanic children being diagnosed with otitis media than Hispanic children (P = 0.049). There were no significant demographic differences in the incidence of children with OM undergoing MT with respect to sex, race, ethnicity, or insurance status. As a specialty, otolaryngology does not appear to exhibit any disparate healthcare access bias in providing MT to children with OM. NA Laryngoscope, 128:2898-2901, 2018.

Surgical management of otitis media in children

Surgical management of otitis media in children

National Institute for Clinical Excellence guidelines on the surgical management of otitis media with effusion: Are they being followed and have they changed practice?

ObjectiveUK National Institute of Clinical Excellence (NICE) guidelines on surgical management of otitis media with effusion (OME) in children call for an initial 3 month period of observation, with ventilation tube (VT) insertion considered for children with persistent bilateral OME with a hearing level in better ear of 25–30dB HL or worse (“core criteria”), or for children not meeting those audiologic criteria but when OME has significant impact on developmental, social or educational status (exceptional circumstances). We aimed to establish whether guidelines are followed and whether they have changed clinical practice. MethodsRetrospective case-notes review in five different centres, analysing practice in accordance with guidelines in all children having first VT insertion before (July–December 06) and after (July–December 08) guidelines introduction. ResultsRecords of 319 children were studied, 173 before and 146 after guidelines introduction. There were no significant differences in practice according to guidelines before and after their introduction with respect to having 2 audiograms 3 months apart (57.8 vs. 54.8%), OME persisting at least 3 months (94.8 vs. 92.5%), or fulfilment of the 25dB audiometric criteria (68.2 vs. 61.0%). Practice in accordance with the core criteria fell significantly from 43.9 to 32.2% (Chi squared p=0.032). However, if the exceptional cases were included there was no significant difference (85.5 vs. 87.0%), as the proportion of exceptional cases rose from 48.3 to 62.2% (Chi squared p=0.021). ConclusionThis study shows that 87.0% of children have VTs inserted in accordance with NICE guidelines providing exceptional cases are included, but only 32.2% comply with the core criteria. A significant number have surgery due to the invoking of exceptional criteria, suggesting that clinicians are personalising the treatment to each individual child.

Surgical management of otitis media with effusion in children – NICE guideline: what paediatricians need to know

#### Why you should be interested Both surgical management and non-surgical management of otitis media with effusion (OME) are reviewed. In addition, specific conditions in which paediatricians are closely involved...

Surgical management of otitis media with effusion in children: summary of NICE guidance

Surgical management of otitis media with effusion in children: summary of NICE guidance

Contact diode laser myringotomy for medium-duration middle ear ventilation in children

To prospectively compare contact diode laser for myringotomy (CDLM) to myringotomy with tube insertion (M&T) for the surgical management of otitis media with effusion (OME) in children. Prospective randomized controlled study at a tertiary care pediatric institution. Thirty children for whom PE tube insertion was indicated were randomized for treatment by CDLM or by M&T, in order to investigate length of time for middle ear ventilation, and complication rates. Surgical time was measured, post-operative parental questionnaires were reviewed, and follow-up examinations were performed. Middle ear ventilation by CDLM or M&T. Middle ear ventilation by CDLM took an average of 4.1min, and was maintained for an average of 3.5 months, compared to surgical time of 10.2min for M&T, and duration of middle ear ventilation of 6.3 months. These differences were statistically significant (p=0.005 for surgical time, and p<0.001 for duration of ventilation). Complication rates were equivalent. CDLM allowed for medium-duration middle ear ventilation in children compared to M&T. Further study to clarify the role of CDLM in the management of OME in children is indicated.

Day-case adenoidectomy: Outcomes are improved using suction coagulation and prophylactic anti-emetic treatment

In 2004, the Department of Health published 10 High Impact Changes across the NHS. Of these, the first was treating day surgery as the norm for elective operations, releasing up to half a million in-patient beds each year. Adenoidectomy is an operation commonly performed in children for upper respiratory tract obstruction and as part of the surgical management of otitis media with effusion. Many surgeons consider the traditional curettage adenoidectomy as an unsatisfactory operation because it is performed blind, and is associated with varying reported levels of post-operative bleeding. Concern about the risk of bleeding and the frequent occurrence of post-operative nausea and vomiting have discouraged many surgeons from adopting adenoidectomy as a day-case procedure. We have audited the management and discharge of a cohort of 72 children undergoing traditional curettage adenoidectomy. Based on the results, we have completed the audit loop, by managing a second cohort of 77 children by suction coagulation adenoidectomy. An anaesthetic protocol has been designed to reduce post-operative nausea and vomiting, and facilitate same day discharge from hospital. The rate of post-operative nausea and vomiting fell from 21 to 1.3%, and the post-operative bleeding from 9.7% to nil. Discharge on the day of operation rose from 40.3 to 100%. Our audit confirms that these measures permit safe, day-case adenoidectomy.

The surgical management of otitis media with effusion in childhood

Objectives: To assess the surgical management for otits media with efusion in childhood,within the North Argyll and Clyde region in Scotland. Methods: A prospective study was designed to assess the management of the condition.The study was conducted over 5 years, between 1996 and 2001. During this time 384 procedures were carried out on 296 patients. Sixty-one patients underwent more than one procedures. Results: The age of the patients varied from 2 to 16 years with a mean of 6 and a median of 6. Unilateral grommet insertion was performed in 80 patients (27%). Within this group the need for a second operation for contra lateral grommet insertion 3 to 6 months postoperatively was common. Eighteen patients (8%) had a worse postoperative PTA than their preoperative one. In 12 (5%) the PTA remained unchanged. The rest of the patients showed an improvement varying from 5 to 50 db with a mean of 14 db and a median of 15 db. Complications following the procedures were noticed in 10 patients (3.4%) and these included 3 patients with perforations following grommet insertion and 6 patients with recurrent acute otitis media and discharge. Conclusion: Although grommet insertion is a quick and safe procedure, it is not completely without risks or complications. The authors recommend that otolaryngologists in Scotland follow the SIGN guidelines.The clinicians could also consider close observation with repeated audiograms and tympanograms, and the option of a temporary hearing aid for controversial cases.

Surgical management of otitis media.

Surgical management of otitis media.

Medical and surgical management of otitis media

At the dawn of the new millennium, we have seen a vigorous clinical response to the changing and challenging problems of otitis media, with a high prevalence, greater bacterial resistance, and even greater educational and occupational impact than previously realized. New medical and surgical treatments and a better understanding of host-disease factors, including genetic and molecular investigations, may emerge from this productive year’s work. This update summarizes the latest epidemiologic and basic science studies, new medications, management of multidrug resistance by changing indications for antibiotic use and dosing regimens, the new pneumococcal vaccine, and the role of laser myringotomy.

Ventilation Tubes and Persisting Tympanic Membrane Perforations

Surgical management of otitis media with effusion and recurrent acute otitis media includes myringotomy and the use of ventilation tubes. Since this procedure was reintroduced by Armstrong in 1954, it has become one of the most commonly performed operations in otolaryngology. In most series perforation of the tympanic membrane in some patients has been reported after spontaneous extrusion or removal of the tympanostomy tubes. We present a retrospective review designed to examine the incidence of persisting perforations of the tympanic membrane in our series of 2604 operated ears. The study also identifies and analyzes the variables and the contributing risk factors. Perforations occurred in 3.06% of the ears: with a greater incidence in children younger than 5 years, when the indication was recurrent purulent otitis media, with the use of long-term Goode T tubes, in cases with repeated insertions of ventilation tubes, and in cases in which postoperative otorrhea was frequent.

Management of otitis media among children in a large health insurance plan.

Otitis media is one of the most common office diagnoses among children in the US and the leading reason for the use of antimicrobials in pediatric practice. We undertook this study to characterize medical and surgical management of otitis media. Using claims data from a large New England health insurer, we identified all children <10 years of age who had one or more episodes of acute otitis media between July, 1995, and June, 1996, and examined patterns of treatment for this condition. Study subjects (n = 22,004) averaged 2.9 physician office visits for management of otitis media; among children <2 years of age, one-fourth had 6 or more such visits. Amoxicillin was prescribed as initial therapy in more than one-half (56.6%) of all episodes of acute otitis media, followed by cephalosporins (18.3%), trimethoprim-sulfamethoxazole (12.3%), macrolides (6.4%) and amoxicillin-clavulanate (6.0%). Over multiple episodes, however, use of amoxicillin declined by about 50%. Antimicrobial prophylaxis was received by 7.3% of all study subjects for a mean of 61.3 days; the incidence of breakthrough episodes of acute otitis media during prophylaxis varied according to the antimicrobial used (13.9, 12.3 and 19.5% for amoxicillin, trimethoprim-sulfamethoxazole and sulfisoxazole, respectively). Surgical procedures related to otitis media were performed on 3.8% of all study subjects, including 4.6% of children <2 years of age. The health care burden of otitis media is large, particularly in the first 2 years of life.

Otologic management in children with the CHARGE association

Objectives: To characterize otologic management of two patient groups, those with the CHARGE association and those not strictly labeled as CHARGE but with several features of the disorder (CHARGE-like), in order to determine: (1) the clinical validity and utility of managing CHARGE-like children in a similar manner to patients with the strictly defined CHARGE association, (2) the progression and prognosis of hearing loss and (3) the identification of factors that may predict the degree of hearing loss. Design: Case series. Setting: Tertiary care urban children's hospital. Patients: 37 children, 22 in the CHARGE group and 15 in the CHARGE-like group. Interventions: Otorhinolaryngologic and audiologic management. Main outcome measures: Otorhinolaryngologic and audiologic evaluation. Results: All patients required otologic and/or audiologic care. Bilateral hearing loss was found in 32 patients (86%) and unilateral hearing loss in five patients (14%) when hearing was assessed in the absence of otitis media. Among the 32 patients with bilateral hearing loss, 31 (97%) were able to be fit with useful hearing aids. External ear anomalies were present in 25/37 (68%) patients, and middle ear and ossicular anomalies were identified in four cases (4/37, 11%). 36/37(97%) patients required surgical management of otitis media. Three patients (3/37, 8%) exhibited radiographic evidence of inner ear deformity. Facial nerve dysfunction was noted in the records of 14/37 (38%) patients. No statistically significant difference was found when CHARGE and CHARGE-like patients were compared for degree of hearing loss ( P=0.5964), type of hearing loss ( P=0.2657), worsening of hearing level ( P=0.7908), or anomalies of the external ear ( P=0.6921), ossicles ( P=0.7908), inner ear ( P=0.7908) or facial nerve ( P=0.6409). Patients with external ear anomalies did not exhibit statistically different degrees ( P=0.3125) or types ( P=0.1515) of hearing loss from patients without auricular anomalies. The presence of facial nerve anomaly correlated significantly ( P=0.0021) with profound hearing loss. Conclusions: Children who are CHARGE-like may be may be considered equivalent in terms of otologic and audiologic management to children strictly defined as CHARGE patients. These children all require otologic care due to the high prevalence of middle ear disease and the underlying permanent hearing loss that is both stable and aidable. The degree of hearing loss cannot be predicted by external ear morphology, but may be predicted by facial nerve palsy.

Surgical management of otitis media

Surgical management of otitis media

Surgical Advances in Treating Otitis Media

Surgical methods of treating otitis media and its sequelae are discussed, according to the classification of otitis media presented in an earlier report. Surgical management of otitis media with effusion and recurrent purulent otitis media includes myringotomy and use of ventilation tubes. Occasionally, otitis media with effusion will lead to structural and other pathologic changes in the middle ear, and conservative treatments such as use of medication or tubes will not suffice. Indications and methods for exploratory tympanotomy and reconstruction of the middle ear are discussed. In such instances, tympanoplasty can be used to the patient's benefit. Chronic otitis media with mastoiditis, defined by the presence of intractable pathologic tissue, generally requires surgical correction. Classic methods include simple mastoidectomy, modified radical (Bondy) mastoidectomy, and radical mastoidectomy. Current classifications of procedures would also include closed-cavity tympanomastoidectomy, open-cavity tympanomastoidectomy, and intact-bridge tympanomastoidectomy (a combined approach). The diagnostic and surgical approach to silent or subclinical otitis media is discussed. Diagnosis and treatment of sequelae of otitis media, including sequelae in the middle ear and, less commonly, in the inner ear, are discussed.

Surgical management of otitis media.

Otitis media is a common childhood condition, yet its treatment remains a subject of debate and even its nomenclature has often changed. Indeed, introduction of the term «otitis media with effusion» has further «muddied the waters» by apparently blurring the distinction between acute and chronic middle ear effusion. The classification of otitis media used in this report is shown in Table 1

Surgical Management of Otitis Media and Otitis Interna

Surgical management of otitis media and otitis interna includes the following options: lateral bulla osteotomy, ventral bulla osteotomy, or curettage of the tympanic cavity. Because otitis media frequently accompanies chronic nonresponsive otitis externa, one of the above procedures may be combined with operative procedures of the external ear canal. Also, gentle selective curettage of the tympanic cavity may be combined with either lateral or ventral bulla osteotomy in the treatment of otitis media and interna. The choice of surgical procedure(s) should be based on the condition of the external ear canal (vertical and horizontal parts), the duration of clinical signs, response to previous surgery, and the familiarity of the surgeon with the different approaches and techniques. With the increased reporting of long-term results following surgical management of otitis externa, media, and interna, more meaningful conclusions concerning selection of surgical procedure may be made in the future.

Surgical management of otitis media (recurrent and nonsuppurative)

In 1977 Paradise outlined the role of tympanostomy tubes in nonsuppurative otitis media. Over the intervening 10 years the role has changed little. Exceptions would be the demonstrated advantage of tube placement over myringotomy alone in those patients with effusion for longer than 2 or 3 months, or over prophylactic sulfonamide or placebo in recurrent otitis media.

Surgical management of otitis media.

In summary there are four surgical procedures commonly used for treatment of otitis media. Myringotomy and aspiration of the middle ear effusion is indicated for acute otitis media: (1) when a child has persistent or recurrent symptoms while on appropriate antimicrobial therapy; (2) if there is severe otalgia initially requiring immediate relief; (3) when a suppurative complication is present, such as facial paralysis; or (4) whenever a diagnostic tympanocentesis (for microbiology) is indicated, such as for the critically ill child, the neonate or a child who is immunologically compromised. In addition the potential benefit from more liberal use of the procedure initially might decrease the persistence and recurrence. Myringotomy without tympanostomy tube insertion is a reasonable treatment option for infants and children with chronic otitis media with effusion that is unresponsive to antimicrobial therapy if the procedure can be performed without the administration of a general anesthetic; however, if not, then a tympanostomy tube should be inserted since the recurrence rate is high. In addition to chronic otitis media with effusion, myringotomy with tympanostomy tube insertion is indicated for: (1) recurrent acute otitis media, especially if unresponsive to prophylactic antimicrobial therapy; (2) eustachian tube dysfunction, in which one or more of the following is present--otalgia, significant and symptomatic hearing loss, vertigo or tinnitus; (3) severe retraction pocket of the tympanic membrane; (4) suppurative complication to maintain adequate drainage; and (5) at the time of repair of a tympanic membrane defect, i.e. tympanoplasty, when the eustachian tube function is poor.(ABSTRACT TRUNCATED AT 250 WORDS)