Ventilation Tube Research Articles

Impact of different medical direction policies on prehospital advanced airway management for out-of hospital cardiac arrest patients: A retrospective cohort study

BackgroundAlthough optimal prehospital airway management after out-of-hospital cardiac arrest (OHCA) remains undetermined, no studies have compared different advanced airway management (AAM) policies adopted by two hospitals in charge of online medical direction by emergency physicians. We examined the impact of two different AAM policies on OHCA patient survival. MethodsThis observational cohort study included adult OHCA patients treated in Okayama City from 2013 to 2016. Patients were divided into two groups: the O group - those treated on odd days when a hospital with a policy favoring laryngeal tube ventilation (LT) supervised, and the E group - those treated on even days when the other hospital with a policy favoring endotracheal intubation (ETI) supervised. Multiple logistic regression analysis was performed to assess airway device effects. The primary outcome measure was seven-day survival. ResultsOf 2,406 eligible patients, 50.1% were in the O group and 49.9% were in the E group. O group patients received less ETI (1.0% vs. 12.0%) and more LT (53.3% vs. 43.0%) compared with E group patients. In univariate analysis, no differences were observed in seven-day survival (9.4% vs 10.1%). Multiple regression analysis revealed neither LT nor ETI had a significant independent effect on seven-day survival, considering bag-valve mask ventilation as a reference (OR, 0.78; 95% CI, 0.54 to 1.13, OR, 0.79; 95% CI, 0.36 to 1.72, respectively). ConclusionDespite different advanced airway medical direction policies in a single city, there were no substantial impact on outcomes for OHCA patients.

Efficacy of Ventilation Tube Insertion with Palatal Repair for Otitis Media in Cleft Palate: Meta-Analysis and Trial Sequential Analysis.

Cleft palate is the most common congenital facial deformity and may result in multiple sequelae and disabilities. One common comorbidity is refractory otitis media with effusion (OME), as patients with cleft palate have impaired eustachian tube function with alteration of the nearby muscular structures. Ventilation tube insertion (VTI) is regarded as an effective mean to address OME in addition to palatal repair surgery. However, controversy regarding the efficacy of VTI and the timing of VTI remains. We aimed to assess the efficacy of VTI with palatal repair for cleft palate on OME development via a meta-analysis with systematic review and trial sequential analysis (TSA). Studies including patients with cleft palate who underwent palatal repair with or without VTI were considered eligible. After searching the Cochrane Library, PubMed, EMBASE, Web of Science, Scopus and China National Knowledge Infrastructure (CNKI) from inception through 5 September 2021, 9 studies involving 929 patients were included. Overall, a significantly higher OME-free rate was noted in those who underwent VTI and palatal repair than in those who underwent palatal repair alone (OR, 2.73; 95% CI, 1.37 to 5.42; p = 0.004; I2 = 84%). Subgroup analysis revealed that the OME-free rate remained higher in the concurrent VTI group (OR, 3.29; 95% CI, 1.64 to 6.59; p < 0.001; I2 = 81%). TSA indicated that all the analyses provided conclusive results by meeting the required information size and Z-value. The meta-analysis indicated that VTI is an effective procedure to prevent OME in patients with cleft palate and that VTI is beneficial when performed concurrently with palatal repair surgery.

Early tracheostomy: on the cutting edge, some benefit more than others.

The decision to undergo early tracheostomy in critically ill patients has been the subject of multiple studies in recent years, including several meta-analyses and a large-scale examination of the National in-patient Sampling (NIS) database. The research has focused on different patient populations, and identified common outcomes measures related to ventilation. At the crux of the new research is the decision to undergo an additional invasive procedure, mainly tracheostomy, rather than attempt endotracheal tube ventilation with or without early extubation. Notably, recent research indicates that neurological and SARS-CoV-2 (COVID-19) patients seem to have an exaggerated benefit from early tracheostomy. Recent studies of patients undergoing early tracheostomy have shown decreases in ventilator associated pneumonia, ventilator duration and duration of ICU stay. However, these studies have shown mixed data with respect to mortality and length of hospitalization. Such advantages only become apparent with large-scale examination. Confounding the overall discussion is that the research has focused on heterogeneous groups, including neurosurgical ICU patients, general ICU patients, and most recently, intubated COVID-19 patients. Specific populations such as neurosurgical and COVID-19 patients have clearly defined benefits following early tracheostomy. Although the benefit is less pronounced, there does seem to be an advantage in general ICU patients with regards to ventilator-free days and lower incidence of ventilator-associated pneumonia. In these patients, large-scale examination points to a clear mortality benefit.

Determining the diagnostic value of tracheal intubation by palpation and auscultation methods compared to the chest X-ray method in children.

BackgroundIt is important to determine the proper location of tracheal tube for proper ventilation. In this study, we compared the diagnostic value of tracheal intubation with two methods of palpation and auscultation with chest X-ray (CXR) method in pediatric.MethodsIn this interventional study, 80 patients under 6 years of age were included. After tracheal intubation appropriate depth of tracheal tube was determined by auscultation and recorded, then by palpation depth of tracheal tube determined and tube was fixed. The length of the tube was calculated with the standard formula based on age. After surgery, CXR was taken and, according to the landmark, the distance from the end of the tube to the anterior lower tooth was recorded.ResultsInterclass correlation coefficient (ICC) between the palpation method and the standard method in the number of fixing tracheal intubation was 0.573, which shows the average and significant correlation between these two methods in determining the fixed number of tracheal intubation. ICC between the auscultation and the standard method in fixing tracheal intubation number was 0.430, which shows the average and significant agreement between these two methods in determining the fixed number of tracheal intubation. There is no significant relationship between sex and the average number of fixing tracheal intubation in all methods.ConclusionsThis study has shown that both palpation and auscultation methods are appropriate, but with a slightly higher palpation ICC, the palpation can be considered relatively better.

Abstract WP128: Race Heterogeneity Potentially Drives The Association Between Hypercholesterolemia And In-hospital Mortality Among Patients With Primary Intracerebral Hemorrhage: Analysis Of 15-year Nationwide Data

Background: The evidence of association between Intracerebral Hemorrhage (ICH) outcomes and hypercholesterolemia (HC) is equivocal. We provide nationwide estimates of ICH in-hospital mortality (IHM) among patients with HC, across race/ethnicity subgroups. Methods: In a pooled cross-sectional analysis of adult (≥ 18 years) primary ICH patients in the National Inpatient Sample (2004 - 2018), we used ICD 9 / 10 codes to identify patients with HC. We fit survey design multivariable logistic regression models to provide nationwide estimates of the association between IHM and HC as adjusted odds ratio (aOR) and 95% confidence interval (CI). Results: Among a total of 803,230 ICH hospitalizations, we identified 56,635 HC ICH patients. HC patients, compared to patients with no hypercholesterolemia (NHC), were older (72.3 vs. 68.7 years), had higher proportional (%) burden of diabetes (35.8 vs. 26.4), hypertension (90.0 vs. 80.9), obesity (9.2 vs. 8.0), atrial fibrillation (22.1 vs. 19.3) and past / current use of anticoagulation (11.9 vs. 9.8). However, HC patients (vs. NHC) were less likely to have extreme loss of function (21.4 vs. 28.7) or receive invasive treatment, including extra-ventricular drain (5.2 vs. 7.6), invasive ventilation (5.7 vs. 7.9), tracheostomy (2.4 vs. 4.2) and gastric tube placement (6.0 vs. 8.5). Overall, and non-Hispanic whites (NHW), non-Hispanic black and Hispanic, HC patients (vs. NHC) had lower IHM (aOR, CI for overall effect: 0.85, 0.81 - 0.90) (Figure 1). The HC - IHM association was significantly modified by age among NHW, whereby the likelihood of IHM among HC (vs. NHC) significantly increased with advancing age (aOR, CI: 1.01, 1.00 - 1.02) (Figure 2). Conclusion: HC is associated with lower ICH severity and IHM, albeit with significant race/ethnic variations. Further evaluation of potential role of genetic, environmental and treatment factors, across race/ethnicity sub-groups, in the relationship between HC and ICH outcomes is warranted.

Efficacy and safety of balloon dilation of eustachian tube in children: Systematic review and meta-analysis

ObjectivesEustachian tube dysfunction is a common condition that may lead to otitis media with effusion, hearing loss and developmental delays in children. We sought to determine the efficacy and safety of balloon dilation of the eustachian tube (BDET) in the pediatric population. Data sourcesOriginal studies of BDET in a pediatric population were identified in PubMed, Embase, Web of Science, Cochrane, Clinicaltrials.gov and CINAHL. MethodsOutcomes of efficacy included audiometric findings and adverse events were summarized for each study. ResultsSeven articles were included involving 408 children with a mean age of 9.9 years old (95%CI 8.8, 11.1) and a mean follow up of 19.2 months (95%CI 15, 23). Type B tympanograms decreased after BDET from 64.2% (95%CI 53.3, 73.8) to 16.1% (95%CI 8.5, 28.4). Air-bone gap (ABG) decreased after BDET from a mean of 25.3 dB (95%CI 18.9, 31.6) to 10.2 dB (95%CI 8.9, 11.5). The pooled estimate of adverse events after BDET was 5.1% (95%CI 3.2, 8.1), the majority being self-limited epistaxis with no major adverse events reported. Three studies compared BDET to ventilation tube insertion; analysis of post-operative ABG showed a greater decrease in the BDET group (mean difference −6.4 dB; 95%CI -9.8, −3.1; p = 0.002). ConclusionAlthough there are no prospective randomized control trials, BDET ± tympanostomy tube placement may produce outcomes that are comparable to tympanostomy tube placement in the treatment of otitis media with effusion in the pediatric population. Most children undergoing the procedure are those with recalcitrant disease. The procedure is safe with the most common complication being epistaxis.

Submersion with grommets: contamination is possible at minimal depth, as demonstrated with a novel middle-ear model.

Advice to patients following grommet insertion and waterproofing can vary from clinician to clinician. A laboratory based experiment was performed to determine at what depth water contamination would occur through various grommet tubes. A novel experimental ear model was developed using an artificial tympanic membrane and ventilation tubes. Water contamination was identified using an effervescent solid that reacts when in contact with water. Measures of dispersion were used to describe the results. The average depth of water contamination was: 19.64 mm (range = 11-33 mm, standard deviation = 5.55 mm) using a Shepard grommet; 20.84 mm (range = 18-26 mm, standard deviation = 1.97 mm) with a titanium grommet; and 21.36 mm (range = 18-33 mm, standard deviation = 3.03 mm) using a T-tube. Water contamination was possible at depths of 11-33 mm. The average pressure at water effervescent activation was 0.20 kPa. Submersion underwater at any depth with grommets is likely to lead to middle-ear contamination. These findings are concordant with clinical studies.

Uniportal thoracoscopic decortication: start away from empyema approach

Aim: Video-assisted thoracoscopic surgery (VATS) is now a gold standard in treating early-stage empyema, while much debate still exists considering the effectiveness of this approach for late-stage empyema. Most concerns arise from the crowded rib cage, narrow working space, and ability to free trapped lungs quickly, mainly if uniportal VATS is used. However, unlike uniportal VATS lobectomy, there is no consensus about standard steps for uniportal VATS decortication to ensure smooth and effective surgery. We try to offer standard, easy-to-replicate steps for this approach to evaluate the efficacy and safety of the “start away from empyema” approach for uniportal VATS decortication in the management of stage II and III empyema. Methods: A prospective case series study has been conducted on 25 patients. All patients with stage II and III empyema were admitted to the Cardiothoracic Surgery Department between October 2017 and March 2020. VATS procedure was done under general anesthesia by a double-lumen tube for selective ventilation. Demographic data, preoperative diagnosis, intraoperative findings, hospital stay, and complications were recorded. Results: Twenty-five patients were enrolled in this study with a median age of 35 years. The duration of illness ranged between 14 and 60 days, with a median (IQR) of 25 (17) days. In (88%) of the patients, there was a successful outcome defined as a near-complete resolution on Chest X-ray (scoring of 3 or 4) and chest US (scoring of 2 or 3). Only three (12%) patients had a partially successful outcome. All patients with partial success suffered from infection associated with malignant effusion. Conclusion: “Start away from empyema” approach for uniportal VATS decortication in stage II and III empyema could be safe and effective in treating loculated nonmalignant pleural effusion.

A clinical study and management of otitis media with effusion in children

One of the most prevalent chronic otological problems in children is otitis media with effusion (OME). By three, two-thirds of children have had at least one episode of OME, and one-third are asymptomatic. Most commonly, hearing loss, delayed speech and language development and poor social conduct in younger children are seen in the pediatric population. Surgical treatment consists of myringotomy and grommet (ventilation or tympanostomy tube) insertion and the removal of the underlying cause as and when indicated. This study was thus undertaken to study the prevalence of otitis media with effusion in children and to assess the improvement in symptomatology after a tympanostomy tube insertion.

A new perspective during laryngo-tracheal surgery: the use of an ultra-thin endotracheal tube (Tritube®) and flow-controlled ventilation—a retrospective case series and a review of the literature

BackgroundUpper airway surgery often poses a challenge to both anesthesiologists and surgeons, as airway access, mechanical ventilation, and surgical difficulties may occur in a tricky combination. To fulfill the need for a tubeless surgery, techniques such as apneic oxygenation or jet ventilation may be used, which carry the risk of several complications. The ultrathin cuffed endotracheal tube Tritube can be used with flow-controlled ventilation (FCV) to provide adequate surgical field and ventilation. To assess the feasibility, safety, and effectiveness of this technique, we describe a series of 21 patients, with various lung conditions, undergoing laryngo-tracheal surgery with FCV delivered via Tritube. Moreover, we perform a narrative systematic review to summarize clinical data on the use of Tritube during upper airway surgery.ResultsAll patients were successfully intubated in one attempt with Tritube. The median (interquartile range [IQR]) tidal volume was 6.7 (6.2–7.1) mL/kg of ideal body weight, the median end-expiratory pressure was 5.3 (5.0–6.4) cmH2O, and the median peak tracheal pressure was 16 (15–18) cmH2O. The median minute volume was 5.3 (5.0–6.4) L/min. Median global alveolar driving pressure was 8 (7–9) cmH2O. The median maximum level of end-tidal CO2 was 39 (35–41) mmHg. During procedures involving laser, the maximum fraction of inspired oxygen was 0.3, with the median lowest peripheral oxygen saturation of 96% (94–96%). No complications associated with intubation or extubation occurred. In one patient, the ventilator needed to be rebooted for a software issue. In two (10%) patients, Tritube needed to be flushed with saline to remove secretions. In all patients, optimal visualization and accessibility of the surgical site were obtained, according to the surgeon in charge. Thirteen studies (seven case reports, two case series, three prospective observational studies, and one randomized controlled trial) were included in the narrative systematic review and described.ConclusionsTritube in combination with FCV provided adequate surgical exposure and ventilation in patients undergoing laryngo-tracheal surgery. While training and experience with this new method is needed, FCV delivered with Tritube may represent an ideal approach that benefits surgeons, anesthesiologists, and patients with difficult airways and compromised lung mechanics.

The Effect of Endoscopic Peritubal Adenoidectomy Vs Myringotomy with Ventilation Tubes Insertion in Management of Otitis Media with Effusion in Children

The Effect of Endoscopic Peritubal Adenoidectomy Vs Myringotomy with Ventilation Tubes Insertion in Management of Otitis Media with Effusion in Children

Experimental study on temperature profile and smoke movement in a model-branched tunnel fire under longitudinal ventilation

Reduced scale experiments in a branched tunnel were carried out to study the temperature profile and critical ventilation velocity under different longitudinal ventilation conditions. Branch orientation was upstream and the branch angle was 15°. The results show that when dimensionless ventilation velocity is lower than 0.19, the maximum temperature is lower than that of traditional single tube tunnel because hot smoke could propagate into the branch. When dimensionless ventilation velocity is higher than 0.19, the maximum temperature is close to that of single tube tunnel. Because more heat is blown downstream, which is similar to ventilated single tube tunnel. A new model predicting the maximum temperature beneath the ceiling is developed. With increasing ventilation velocity, the upstream and branch temperature decay factor increase while the downstream temperature factor decrease. Critical ventilation velocity for the branched tunnel is higher than that of single tube tunnel. A correlation of critical ventilation velocity is proposed. The 1/3 power law still holds.

A randomised clinical trial of single or extended dosing ciprofloxacin versus no intervention for prevention of ventilation tube otorrhoea and obstruction (PreVenTO2).

To determine the effectiveness of ciprofloxacin .3% antibiotic eardrops in preventing clinically significant postoperative otorrhoea and tube obstruction following grommet insertion in children. Three-arm parallel assessor-blinded randomised controlled trial. Randomisation in 1:1:1 ratio to single intraoperative application of ciprofloxacin drops, extended 5day postoperative application and no drops. Patients were assessed by blinded assessors at 6weeks postoperatively. The study was conducted in a large tertiary health network in Melbourne, Australia. All children, 17years and under, undergoing bilateral middle ear ventilation tube surgery with or without concurrent upper airway surgery for recurrent acute otitis media and chronic otitis media with effusion were approached. Presence of postoperative otorrhoea and ventilation tube obstruction at 6weeks postoperatively. Two-hundred and fifty-six paediatric patients completed the study with a median age of 4.02years. One-hundred and fifty-three participants were male. Ear analysis (n=512) showed intraoperative antibiotics were more effective than no drops in preventing otorrhoea (RR=.341, 95% CI .158-.738, NNT=11.25, p=.006). Postoperative antibiotics were more effective than no drops in preventing ventilation tube obstruction (RR=.424, 95% CI .193 to .930, NNT=14.7, p=.032). Intraoperative topical ciprofloxacin was effective at preventing early postoperative otorrhoea, and a prolonged course was effective at preventing ventilation tube obstruction. Future studies on this topic should seek to clarify whether particular subgroups of patients benefit more from prophylactic topical antibiotics and model for cost-effectiveness.

Ensuring optimal ventilation of calf buildings

Background: There has been considerable change over the past 10 years in the perceived value of beef and dairy calves, with potential for improvement to animal health and farm financial sustainability. One of the main calf health issues is respiratory disease, with multifactorial aspects that all require attention in order to produce healthy calves. Poor ventilation is often cited as a contributing factor to respiratory problems on specific farms, but it is seldom described in an objective manner that would facilitate providing an effective solution.Aim of the article: This article outlines the importance of fresh air in calf houses on calf health, with specific focus on natural ventilation, stack effect and positive pressure tube ventilation.

Discussion on timing and method of surgical treatment for infants with middle ear effusion

Objective:To investigate the timing and method of surgical intervention for neonates diagnosed with middle ear effusion after hearing screening failure. Methods:① A total of 103 children were enrolled in this study and received follow-up evaluations for every month. ② After the first follow-up period for 3 months, the uncured cases were divided into three groups according to the course of the illness. Group Ⅰ is the group of improvement, group Ⅱ is the group of relapse, and the group Ⅲ is the persistent group. The infants will receive symptomatic treatment if necessary. After 6 months, surgical treatment would be recommended in the persistent cases and aggravation, the cases of improvement and cases that the parents don't receive the operation would continue to be observed. All patients were observed till they were cured or operated. The operation was performed with tympanostomy and ventilation tube insertion if necessary. ③The distribution of self-healing time was analyzed. Compare the difference of the number of the cases who followed up for 3 months, 6 months and finally recovered naturally. The self-healing rates of different influencing factors were compared. The final operation rate of group Ⅰ, groupⅡ and group Ⅲ were compared. Results:① The median distribution of self-healing time（month age） in 103 cases was 7.00[5.76, 8.24], and the number of self-healing cases decreased significantly after 9 months of age. There were 43 cases（41.75%）, 67 cases（65.5%） and 81 cases（78.64%） recovered naturally after 3 months, 6 months and follow-up in the end, and the difference was statistically significant. ②The self-healing rate of maxillofacial deformities was the lowest（8.33%）, and the difference was statistically significant compared with other factors. ③The final 22 cases underwent surgical treatment, including 1 case in group Ⅰ（3.45%）, 4 cases in group Ⅱ（30.77%）, and 17 cases in group Ⅲ（94.45%）, with statistically significant difference. ④17 children underwent tympanoplasty, 1 patient underwent tympanoplasty and adenoidectomy, and 4 children only underwent tympanotomy. The hearing of 22 cases returned to normal after operation, but 4 cases of patients with tympanotomy had recurrent tympanic effusion, among which 2 cases had serious effusion and had to be operated again. Conclusion:The infants diagnosed with tympanic effusion can be observed for more than 6 months before surgical intervention is considered. The characteristics of disease course and influencing factors during the follow-up period are of great significance to determine the time of surgical intervention for tympanic effusion in infants. Due to the long observation period, the operative method is suggested to perform tympanotomy tubes, and the possibility of recurrence after tympanotomy is high.

Tympanic membrane reconstruction of a persistent perforation associated with massive myringosclerosis in a girl with achondroplasia – case report

Achondroplasia is a genetic disease connected with improper function of fibroblast growth factor receptor 3 (FGFR3) resulting in musculoskeletal disorders. Apart from characteristic musculoskeletal abnormalities (short statute with short proximal limb segments, prominent forehead, midface hypoplasia and a depressed nasal bridge) and generalized hypotonia it also affects otolaryngological field in a form of sleep-related upper respiratory tract disorders (obstructive and central apnea) and conductive hearing loss. This is the result of anatomical phenotype, together with Eustachian tube dysfunction. Interestingly, up to 25% of children with achondroplasia may fail hearing screening in one or both ears. In most cases laryngological disorders require surgical procedures, usually adenotomy, adenotonsillectomy, tonsillectomy or tube placement. Such surgical interventions increase the risk of complications, especially when repeated. We would like to present a case of a girl with achondroplasia that was qualified for myringoplasty because of persistent tympanic membrane perforation due to surgical extrusion of persistent ventilation tube, with associated massive myryngoslerosis.

Study on changes of nasal resistance based on 3D printing transparent nasal cavity models

Objective:To investigate the causal relationship between the minimum cross-sectional area of nasal cavity and nasal resistance. Methods:Thirty transparent detachable 3D printing nasal cavity models were made. The airway was completely blocked with sealing material at different anatomical sections. Then ventilatable nasal drainage tubes with different cross-sectional areas were used to pass through the nasal cavity. Nasal resistance was measured. SPSS was used for statistical analysis. Results:①The postoperative nasal resistances of patients and 3D printing nasal cavity models were （0.38±0.15）Pa· s/mL and （0.39±0.02）Pa· s/mL respectively. There was no statistical difference between the two groups.The preoperative nasal resistance of patients was （0.56±0.09）Pa· s/mL, and the postoperative nasal resistance of the models was significantly descreased by 31% compared with preoperative nasal resistance of the patients, with statistically significant difference（P<0.05）. ②When the ventilatable nasal drainage tubes with a cross-sectional area of 3.14 square millimeters was located in the the upper part of common meatus and the nasal valve area, the nasal cavity is moderately blocked, and the nasal resistances were （1.80±0.30） times and （2.02±0.36） times of that before the obstruction respectively. When the ventilatable nasal drainage tube was located in the lower part of common meatus,the nasal resistance was （1.68±0.28） times of that before the obstruction. ③When the ventilatable nasal drainage tubes with a cross-sectional area of 6.28 square millimeters and were located in the lower part of common meatus, the upper part of common meatus and nasal valve area, the nasal resistances were （1.44±0.23） times, （1.50±0.25） times and （1.60±0.27） times of those before obstruction, respectively. ④When the ventilatable nasal drainage tubes with a cross-sectional area of 9.42 square millimeters were located in the above areas, nasal ventilation was nearly normal without obvious nasal obstruction. The nasal resistances were （1.17±0.18） times, （1.26±0.21） times and （1.33±0.24） times of those before obstruction, respectively. ⑤The nasal resistance was statistically significant correlated with the cross-sectional area of the ventilation tubes and the obstruction sites. The correlation coefficients were -0.895 and 0.339, respectively （P<0.05）. Conclusion:①3D printing can quickly and accurately replicate anatomical structure of the nasal cavity, and can be used as a research method for quantifitative measurement of nasal resistance. ②The minimum cross-sectional area of nasal cavitiy is the main determinant of nasal resistance. ③The obstruction site is the secondary determinant of nasal resistance. When the degree of nasal obstruction is the same , the nasal resistance in the nasal valve area is sightly higher than that in the common meatus.

Congenital anomalies of the large intrathoracic airways

Congenital lung lesions are numerous but rare in individual clinical practice. They do require close multidisciplinary collaboration between health care professionals. This educational review will focus on the pathophysiology, clinical manifestations, surgical approaches, and anesthetic management of congenital anomalies of the large intrathoracic airways: congenital tracheal stenosis, tracheal agenesis, tracheal diverticulum, bronchial anomalies (tracheal, esophageal, or bridging bronchus), congenital lung malformations, lung sequestrations and Scimitar syndrome, lobar emphysema, Williams-Campbell syndrome, and pleuropulmonary blastoma. In addition, this review will illustrate common pitfalls and challenges related to the anesthesia management with emphasis on ventilation and correct endotracheal tube positioning.

Effectiveness of Surgical Approach of Insertion Ventilation Tubes (Tympanostomy) and Adenoidectomy in Comparison with Non-Surgical Approach (Watchful Waiting Approach) in Children at the Age between 1 and 6 and Who Suffer from Otitis Media with Effusion (OME) in 12-Month Period of Observation-The Retrospective Analysis.

(1) Background: Otitis media with effusion (OME) is one of the most common diseases in childhood. The objective was to assess clinically the effectiveness of the surgical approach (tube insertion with adenoidectomy) in comparison with the non-surgical approach (watchful waiting) during a 12-month observation period. (2) Methods: This study was retrospective and obtained approval from the bioethics committee. The criteria of inclusion in the first group (surgical approach) were: (1) a diagnosis of chronic otitis media with effusion in children aged between 1 and 6 years; (2) their medical history showed that they had undergone adenoidectomy and tympanostomy with the insertion of ventilation tubes (VTs). The criteria for inclusion in the second group (non-surgery) were similar to the first group except that their medical history showed they had not undergone adenoidectomy or tympanostomy with the insertion of VTs. There were 422 children included in the surgical group and 50 children in the non-surgical group, and the period of observation was 12 months. (3) Results: For the entire surgical group, the number of healthy days ranged from 20 to 365, with a mean of 328.0 days (SD = 91.4).In the non-surgical group, the number of healthy days ranged from 13 to 365, with a mean of 169.2 days (SD = 127.3). The difference in the number of healthy days was statistically significant (p < 0.001). The certainty of treatment in the first group was higher than in the second group, and the number of days without recurrence was significantly higher than in the second group. In the first group, there were 71 recurrences from 422 children (16.8%), and, in the second subgroup, there were 40 recurrences of acute otitis media (AOM) from 50 children (80%). The RR was 0.21. (4) Conclusions: The surgical approach in children aged 1–6 years who have been diagnosed with otitis media with effusion is reasonable and beneficial for the child.

When Should a Retained Tympanostomy Tube be Removed?

When Should a Retained Tympanostomy Tube be Removed?