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Wie K, Shaw S, Allen P, Castle M, McKenna M, Faria J. Risk Factors for Replacement of Tympanostomy Tubes After Surgical Removal for Pediatric Patients. Otolaryngol Head Neck Surg 2024. [PMID: 39015070 DOI: 10.1002/ohn.909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 06/11/2024] [Accepted: 07/05/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVES Ear tube removal and patch myringoplasty are frequently performed. The indication and timing for surgery varies among otolaryngologists. This study identifies risk factors associated with the need for the replacement of tympanostomy tubes after tube removal and myringoplasty. STUDY DESIGN Case series with chart review. SETTING Single institution academic otolaryngology practice. METHODS Patients younger than 12 years of age who underwent tympanostomy tube removal and myringoplasty at the University of Rochester Medical Center from March 2011 to September 2019. Patients with tympanostomy tube removal due to chronic otorrhea were excluded. RESULTS One hundred sixty-one patients (230 ears) met inclusion criteria and had sufficient follow-up. Myringoplasty success after tube removal was 94.8%. Successful myringoplasty was associated with shorter tube duration (32 months) versus unsuccessful myringoplasty (40 months) (P = .02). Replacement tympanostomy tubes after myringoplasty occurred in 9.6% of ears. There was no difference in average patient age (P = .96) or duration of tubes (P = .74) in patients who required replacement of tympanostomy tubes versus patients who did not require tube replacement. Patients with a cleft abnormality were more likely to require tympanostomy tube replacement (P < .001). CONCLUSIONS Most children do not need tubes replaced after removal. This study identified cleft abnormality as a factor that increased the need for replacement tubes. Longer tube durations of over 3 years negatively impacted myringoplasty success. Tympanostomy tube removal should be considered 2 to 3 years after placement in most patients with longer tube durations considered in children with a repaired cleft palate.
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Affiliation(s)
- Kathryn Wie
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
| | - Shalini Shaw
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Paul Allen
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
| | - Michael Castle
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
| | - Margo McKenna
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
| | - John Faria
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
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The Impact of Lateral Relaxing Incision on Middle Ear Function in Cleft Palate Repair. J Craniofac Surg 2023; 34:e277-e281. [PMID: 36872493 DOI: 10.1097/scs.0000000000009206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/05/2022] [Indexed: 03/07/2023] Open
Abstract
Children with cleft palate are susceptible to otitis media with effusion. This study aimed to investigate the effect of lateral relaxing incision (RI) on middle ear function in cleft palate patients who underwent palatoplasty using double-opposing Z-plasty (DOZ). This is a retrospective study of patients who underwent bilateral ventilation tube insertion concurrently with DOZ, wherein RI was selectively performed on the right side of the palate (Rt-RI group) or not (No-RI group). The frequency of VTI, duration of the first ventilation tube retention, and hearing outcomes at the last follow-up were reviewed. Outcomes were compared using the χ2 test and t test. A total of 126 treated ears from 63 non-syndromic children (18 male, 45 female) with cleft palate were reviewed. The mean age at surgery was 15.8±6.17 months. There were no significant differences in the frequency of ventilation tube insertion between the right and left ears within the Rt-RI group or between the Rt-RI and no-RI groups in the right ear. Subgroup analysis for ventilation tube retention time, auditory brainstem response thresholds, and air-conduction pure tone averages showed no significant differences. In the DOZ, the use of RI had no significant effects on middle ear outcomes during 3 years of follow-up. Relaxing incision seems to be safe without concern for middle ear function in children with cleft palate.
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Alaraifi AK, Alkhaldi AS, Ababtain IS, Alsaab F. Predictors of Otitis Media with Effusion Recurrence Following Myringotomy. Indian J Otolaryngol Head Neck Surg 2022; 74:4053-4058. [PMID: 36742680 PMCID: PMC9895307 DOI: 10.1007/s12070-021-02817-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/08/2021] [Indexed: 02/07/2023] Open
Abstract
Otitis media with effusion (OME) is the most common cause of acquired pediatric hearing loss. The treatment of persistent OME includes myringotomy with or without tube insertion, with a reported recurrence rate of 19.9-40%. This study aims to investigate the recurrence rate of OME and its predictors following myringotomy. A retrospective study that included 345 ears that underwent myringotomy for persistent OME in 179 pediatric patients during 2016-2018. Patients were followed for 36-48 months post myringotomy procedure to detect the recurrence rate. The study sample was divided into two groups based on recurrence status, and the groups were compared using chi-square test and independent T-test. Significant variables (p-value ≤ 0.05) were included in the logistic regression model to determine the predictors of OME recurrence after myringotomy. OME recurrence was detected in 85 ears (24.64%). The OME recurrence rate is higher in patients who underwent myringotomy alone compared to myringotomy with tube insertion (44.1% vs. 22.8%). The insertion of a tympanostomy tube decreases the recurrence rate of OME by 59.9% (OR 0.401; 95% CI 0.162-0.933). The other socio-demographic and clinical characteristics such as age, siblings, daycare attendance, passive smoking, previous acute otitis media, atopy, and adenoidectomy did not significantly influence OME recurrence (p-value > 0.05). The recurrence rate of OME following myringotomy is high. Myringotomy with tube insertion significantly decreases the recurrence rate and the need for further surgeries compared to myringotomy alone. Adenoidectomy and the patient's age have no impact on the recurrence rate of OME.
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Affiliation(s)
- Abdulaziz K. Alaraifi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, 11426 Saudi Arabia
| | - Abdullah S. Alkhaldi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ibrahim S. Ababtain
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Fahad Alsaab
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, 11426 Saudi Arabia
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Lombo C, Costa R, Martins M, Matos C, Fonseca R. Predictive factors for repeated tympanostomy tube placement in children. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 73:356-361. [DOI: 10.1016/j.otoeng.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/01/2021] [Indexed: 11/18/2022]
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Celik O, Ulkumen B, Eskiizmir G, Kamiloglu U, Canbazgil E. LONG-TERM functional results and effectiveness of tympanostomy tubes in pediatric chronic otitis media with effusion. Int J Pediatr Otorhinolaryngol 2022; 161:111255. [PMID: 35964491 DOI: 10.1016/j.ijporl.2022.111255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/07/2022] [Accepted: 07/23/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Onur Celik
- Manisa Celal Bayar University, Department of Otorhinolaryngology-Head Neck Surgery, Manisa, Turkey
| | - Burak Ulkumen
- Manisa Celal Bayar University, Department of Otorhinolaryngology-Head Neck Surgery, Manisa, Turkey.
| | - Gorkem Eskiizmir
- Manisa Celal Bayar University, Department of Otorhinolaryngology-Head Neck Surgery, Manisa, Turkey
| | - Ugur Kamiloglu
- Manisa Celal Bayar University, Department of Otorhinolaryngology-Head Neck Surgery, Manisa, Turkey
| | - Emel Canbazgil
- Manisa Celal Bayar University, Department of Otorhinolaryngology-Head Neck Surgery, Audio-vestibular Unit, Manisa, Turkey
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Otsuka S, Imai R, Kamakura T, Nishimura H, Osaki Y, Furukawa M, Yasui T, Yamashita M, Nakamura M, Iwamoto Y, Kanazu K, Yonei S, Okazaki S, Hirose M. How long do tympanostomy ventilation tubes last in pediatric patients with otitis media with effusion or adhesion? A study using Kaplan-Meier survival analysis. Int J Pediatr Otorhinolaryngol 2022; 159:111210. [PMID: 35724491 DOI: 10.1016/j.ijporl.2022.111210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/26/2022] [Accepted: 06/09/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the functional duration and survival rate of tympanostomy ventilation tubes and the complications associated with their use in pediatric patients who underwent tube insertion for otitis media with effusion (OME). Complications were analyzed including recurrence and tympanic membrane perforation after the tube removal or extrusion. METHODS Altogether, 447 ears from 234 pediatric patients younger than 15 years of age were studied retrospectively. All patients had undergone long-term tympanostomy ventilation tube: the Goode T-tube insertion for OME at the Osaka Women's and Children's Hospital, which is the pediatrics specialty hospital between April 2014 and March 2016. They were typically followed up every 3-4 months or more frequently if necessary due to otorrhea or tube infection. Subsequently, the tube duration, survival rates of the tube especially at 22 months after insertion defined as "full-term placement", and the rates of recurrence and perforation were calculated and statistically evaluated. RESULTS Of 447 ears, 335 ears from 184 patients underwent their first tube insertion, and 112 ears from 64 patients underwent their second or subsequent tube insertion within the targeted period. Two hundred ears from 106 patients were associated with a cleft palate. The survival rate at full-term placement was 51.7%. The recurrence rate was 56.3%, and the rate of the tympanic perforation was 8.5%. CONCLUSIONS Approximately half of the tubes survived for 22 months. The perforation rate was relatively low; however, recurrence of OME was seen in more than half the ears.
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Affiliation(s)
- Shintaro Otsuka
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otorhinolaryngology, Nara City Hospital, 1-50-1 Higashikideracho, Nara, Nara, 630-8305, Japan
| | - Ryusuke Imai
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Takefumi Kamakura
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Hiroshi Nishimura
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otolaryngology-Head and Neck Surgery, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan
| | - Yasuhiro Osaki
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otolaryngology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Masashi Furukawa
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Furukawa ENT Clinic, 5-1 Oharacho, Ashiya, Hyogo, 659-0092, Japan
| | - Toshimichi Yasui
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Yasui ENT Clinic, 1294-1 Minaminakayasumatsu, Izumisano, Osaka, 598-0033, Japan
| | - Maki Yamashita
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojimaku, Osaka, 534-0021, Japan
| | - Megumi Nakamura
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojimaku, Osaka, 534-0021, Japan
| | - Yoriko Iwamoto
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Kimi Kanazu
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Shinichi Yonei
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otolaryngology-Head and Neck Surgery, Higashiosaka City Medical Center, 3-4-5 Nishiiwata, Higashiosaka, Osaka, 578-8588, Japan
| | - Suzuyo Okazaki
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Masayuki Hirose
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
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Aboueisha MA, Attia AS, McCoul ED, Carter J. Efficacy and safety of balloon dilation of eustachian tube in children: Systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2022; 154:111048. [PMID: 35085875 DOI: 10.1016/j.ijporl.2022.111048] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/11/2021] [Accepted: 01/16/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Eustachian 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 SOURCES Original studies of BDET in a pediatric population were identified in PubMed, Embase, Web of Science, Cochrane, Clinicaltrials.gov and CINAHL. METHODS Outcomes of efficacy included audiometric findings and adverse events were summarized for each study. RESULTS Seven 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). CONCLUSION Although 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.
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Affiliation(s)
- Mohamed A Aboueisha
- Department of Otolaryngology-Head and Neck Surgery Faculty of Medicine, Suez Canal University, Egypt; Department of Surgery, Tulane School of Medicine, New Orleans, LA, USA
| | - Abdallah S Attia
- Department of Surgery, Tulane School of Medicine, New Orleans, LA, USA
| | - Edward D McCoul
- Department of Otorhinolaryngology, Ochsner Clinic, New Orleans, LA, USA; Ochsner Clinical School, University of Queensland, New Orleans, LA, USA
| | - John Carter
- Department of Otorhinolaryngology, Ochsner Clinic, New Orleans, LA, USA; Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, LA, USA.
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王 梦, 景 红, 郭 红, 李 雪, 孙 建. [Evaluation of Eustachian tube function in children with adenoid hypertrophy by nasopharyngeal digital photography and ETDQ-7 scores]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:24-26. [PMID: 34979614 PMCID: PMC10128219 DOI: 10.13201/j.issn.2096-7993.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Indexed: 06/14/2023]
Abstract
Objective:To evaluate the Eustachian tube function of children with simple adenoid hypertrophy and adenoid hypertrophy with secretory otitis media(OME) by using the A/N value of lateral radiograph of nasopharyngeal X-ray and EDQ-7 scale scores. Methods:Sixty cases of children with adenoid hypertrophy admitted from February 2019 to August 2021 were all underwent nasopharyngeal X-ray lateral radiographs to determine the adenoid/nasopharyngeal cavity ratio(A/N ratio) and then determine the size of adenoids. The Eustachian tube function ETDQ-7 survey was used to evaluate the patient's self-evaluation of the severity of the disease and ear symptoms, and the degree of influence were scored. Subsequently, the correlation between adenoid hypertrophy with OME and ETDQ-7 scores was statistically analyzed by using the Spearman rank correlation statistical method. Results:In adenoid hypertrophy with OME group, the ETDQ-7 scores of A/N≤0.60, A/N 0.61-0.70 and A/N≥0.71 were 4.15±1.75, 14.55±6.67 and 23.95±6.63, respectively. The higher the grade of adenoid hypertrophy, the higher the ETDQ-7 scores. In adenoid hypertrophy with OME group, the degree of adenoid hypertrophy was positively correlated with the ETDQ-7 scores(P<0.05). Conclusion:Adenoid hypertrophy is also one of the potential factors causing OME in children.
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Affiliation(s)
- 梦航 王
- 北京大学国际医院耳鼻咽喉头颈外科(北京,102206)Department of Otolaryngology Head and Neck Surgery, Peking University International Hospital, Beijing, 102206, China
| | - 红 景
- 北京大学国际医院儿科Department of Pediatrics, Peking University International Hospital
| | - 红光 郭
- 北京大学国际医院耳鼻咽喉头颈外科(北京,102206)Department of Otolaryngology Head and Neck Surgery, Peking University International Hospital, Beijing, 102206, China
| | - 雪盛 李
- 北京大学国际医院耳鼻咽喉头颈外科(北京,102206)Department of Otolaryngology Head and Neck Surgery, Peking University International Hospital, Beijing, 102206, China
| | - 建军 孙
- 北京大学国际医院耳鼻咽喉头颈外科(北京,102206)Department of Otolaryngology Head and Neck Surgery, Peking University International Hospital, Beijing, 102206, China
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Lombo C, Costa R, Martins M, Matos C, Fonseca R. Predictive factors for repeated tympanostomy tube placement in children. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021. [DOI: 10.1016/j.otorri.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kloosterman N, Donnell N, Somers E, Chen H, Kirse D, Whigham AS. Middle ear disease requiring myringotomy in the first two years after tracheotomy in the pediatric population. Int J Pediatr Otorhinolaryngol 2021; 150:110864. [PMID: 34411868 DOI: 10.1016/j.ijporl.2021.110864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/23/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Risk factors for middle ear disease necessitating myringotomy with tympanostomy tube placement after a tracheostomy have not been thoroughly explored. This study investigates the incidence and risk factors for ear tube placement in pediatric patients with a tracheostomy. METHODS Pediatric patients under age 18 who underwent tracheotomy between 2002 and 2010 at two institutions were identified. Patients were excluded if they had undergone myringotomy prior to, or at the same time as, the tracheotomy, or did not have at least two years of follow-up clinic visits. The presence of other comorbidities was recorded. Descriptive statistics and logistic regression models were used to assess the impact of clinical characteristics on outcomes. RESULTS A total of 214 patients met inclusion criteria. Median patient age at time of tracheotomy was 6 months (IQR 2-17), median patient age at time of myringotomy with tubes was 12 months (IQR8-17), and median time between tracheotomy and myringotomy with tube placement was 8 months (IQR 5-11). Sixty-seven (31%) patients required myringotomy with tympanostomy tube placement within the first two years after tracheotomy. Fifty-eight (87%) patients who underwent myringotomy with tympanostomy tubes were younger than 2 years at the time of the procedure. Logistical regression found younger age at time of tracheotomy to be a risk factor (OR: 0.71, 95% CI: 0.5-0.9, p < 0.006). The combination of tracheostomy with gastric tube increased the risk of requiring myringotomy with tubes 2.79 fold (p < 0.009). Craniofacial abnormalities (p < 0.001), known genetic syndrome (p = 0.009), cleft palate (p < 0.001), age at time of tracheotomy (p < 0.001) and gastric tubes (p = 0.002) were all independently found to increase risk of myringotomy with tubes. Patients' gestational age (p = 0.411), ventilator dependence (p = 0.33), and airway structural abnormalities (p = 0.632) did not increase this risk. CONCLUSION This study reports a high incidence of myringotomy with tubes in children with tracheostomy relative to the general pediatric population. Many comorbid conditions that often accompany the need for tracheotomy place these patients at a higher risk for ear disease requiring surgical intervention. Risk factors for operative middle ear disease in this population included age at time of tracheostomy, craniofacial abnormalities, and presence of a G-tube.
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Affiliation(s)
| | | | - Evan Somers
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Heidi Chen
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Daniel Kirse
- Department of Otolaryngology - Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amy S Whigham
- Vanderbilt University School of Medicine, Nashville, TN, USA; Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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Sun PP, Won J, Choo-Kang G, Li S, Chen W, Monroy GL, Chaney EJ, Boppart SA, Eden JG, Nguyen TH. Inactivation and sensitization of Pseudomonas aeruginosa by microplasma jet array for treating otitis media. NPJ Biofilms Microbiomes 2021; 7:48. [PMID: 34078901 PMCID: PMC8172902 DOI: 10.1038/s41522-021-00219-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/28/2021] [Indexed: 02/04/2023] Open
Abstract
Otitis media (OM), known as a middle ear infection, is the leading cause of antibiotic prescriptions for children. With wide-spread use of antibiotics in OM, resistance to antibiotics continues to decrease the efficacy of the treatment. Furthermore, as the presence of a middle ear biofilm has contributed to this reduced susceptibility to antimicrobials, effective interventions are necessary. A miniaturized 3D-printed microplasma jet array has been developed to inactivate Pseudomonas aeruginosa, a common bacterial strain associated with OM. The experiments demonstrate the disruption of planktonic and biofilm P. aeruginosa by long-lived molecular species generated by microplasma, as well as the synergy of combining microplasma treatment with antibiotic therapy. In addition, a middle ear phantom model was developed with an excised rat eardrum to investigate the antimicrobial effects of microplasma on bacteria located behind the eardrum, as in a patient-relevant setup. These results suggest the potential for microplasma as a new treatment paradigm for OM.
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Affiliation(s)
- Peter P Sun
- Department of Civil and Environmental Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
- N. Holonyak, Jr. Micro and Nanotechnology Laboratory, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Jungeun Won
- Department of Bioengineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Gabrielle Choo-Kang
- Department of Civil and Environmental Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Shouyan Li
- Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Wenyuan Chen
- Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Guillermo L Monroy
- Department of Bioengineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Eric J Chaney
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Stephen A Boppart
- Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA.
- Department of Bioengineering, University of Illinois Urbana-Champaign, Urbana, IL, USA.
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA.
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign, IL, USA.
| | - J Gary Eden
- N. Holonyak, Jr. Micro and Nanotechnology Laboratory, University of Illinois Urbana-Champaign, Urbana, IL, USA.
- Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA.
| | - Thanh H Nguyen
- Department of Civil and Environmental Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA.
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign, IL, USA.
- Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana-Champaign, Urbana, IL, USA.
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Lin YC, Kao YL, Chen YC, Chen LC, Dang LH, Hung SH. Factors Related to Ventilation Tube Extrusion Time in Children and Adults. EAR, NOSE & THROAT JOURNAL 2021; 102:NP169-NP176. [PMID: 33720800 DOI: 10.1177/0145561321999204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to investigate the factors affecting extrusion time in both children and adults with ventilation tube (VT) insertion, providing useful information for clinicians for better decision-making, follow strategy, and potentially improve clinical outcomes for these patients. METHODS Data from patients receiving myringotomy with VT insertion from January 1, 2007, to June 30, 2012, were retrospectively collected and analyzed by the end of 2018. Various factors, including age, gender, history of VT insertion, tympanogram, size of VT used, local finding of tympanic membrane, hypertension, diabetes mellitus, hyperlipidemia, and postoperative ear infection, were included and analyzed to examine the effects of these factors on extrusion time. RESULTS A total of 447 patients were included in this study (Child group-Adult group = 237:210). The overall average extrusion time was 225.85 days. In the subgroup analysis, the average time was 221.3 days and 231.0 days for children and adults, respectively. The results showed that the VT extrusion time was significantly longer in participants without a history of VT insertion and in those where larger sized VTs were inserted in both age-groups. Male gender had an influence on extrusion time in children. In addition, a history of VT insertion and VT size were determined to be factors related to extrusion before 12 months in children. CONCLUSION History of VT insertion and VT size were significantly related to VT extrusion time in both children and adults and defined as factors associated with extrusion before 12 months in children. The findings suggest avoiding VT with a diameter < 1 mm and considering an appropriately larger size in patients with a history of VT insertion to optimize VT retention.
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Affiliation(s)
- Yi-Chih Lin
- Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, Taipei
| | - Yi-Lin Kao
- Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei
| | - Yen-Chun Chen
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei
| | - Lung-Che Chen
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei
| | - Luong Huu Dang
- Department of Otolaryngology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Shih-Han Hung
- Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei.,International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei.,Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei
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Kaffenberger TM, Belsky MA, Oberlies NR, Kumar A, Donohue JP, Yang TS, Shaffer AD, Chi DH. Long-term Impact of Middle Ear Effusion in Pediatric Tympanostomy Tubes. Laryngoscope 2020; 131:E993-E997. [PMID: 32621539 DOI: 10.1002/lary.28860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/12/2020] [Accepted: 05/20/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Bilateral myringotomy and tympanostomy tube placement (BMT) is the most common pediatric surgery in the United States. Intraoperative middle ear effusion (MEE) is a risk factor for future BMTs in children with recurrent acute otitis media (RAOM). However, the impact of the type of MEE is unknown. Here, we assess otologic outcomes based on intraoperative MEE type and indication for surgery. STUDY DESIGN Case series chart review. METHODS After institutional review board approval, we performed a review of children undergoing BMTs between 2008 and 2009. Included patients had their first BMT, preoperative visit, and an operative report. Patients with cleft palate or Down syndrome were excluded. Indications for surgery included RAOM and chronic otitis media with effusion (COME). Other variables evaluated were future BMT, acquired cholesteatoma, and otorrhea. Logistic regression was used for statistical analysis. RESULTS Out of 1,045 patients reviewed, 680 were included and underwent their first BMT. There were 619 patients who had RAOM. Serous effusions were present in 22.2%, mucoid in 31.3%, purulent in 12.9%, undocumented or bloody in 2.3% of patients, and 31.2% of patients had dry middle ears. Moreover, 22.7% of patients underwent future BMTs. In RAOM patients, serous effusions decreased odds of perforation (odds ratio [OR]: 0.195, 95% confidence interval [CI]: 0.0438-0.867, P = .032), and purulent effusions increased the odds of in-office otorrhea suctioning (OR: 2.13, 95% CI: 1.20-3.77, P = .010) compared to dry. Mucoid effusions had no significant effect on outcomes in COME or RAOM patients. CONCLUSIONS Intraoperative MEEs were noted in 68.7% of cases; purulent effusions increase the odds of in-office suctioning in RAOM patients. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E993-E997, 2021.
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Affiliation(s)
- Thomas M Kaffenberger
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Michael A Belsky
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Nicholas R Oberlies
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Aarti Kumar
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Joseph P Donohue
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Tiffany S Yang
- University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Amber D Shaffer
- University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - David H Chi
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.,University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
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Ma Q, Wang H, Chen ZN, Wu YQ, Yu DZ, Wang PJ, Shi HB, Su KM. Removal of biofilm is essential for long-term ventilation tube retention. World J Clin Cases 2020; 8:1592-1599. [PMID: 32432137 PMCID: PMC7211535 DOI: 10.12998/wjcc.v8.i9.1592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/04/2020] [Accepted: 04/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although long-term retention of a ventilation tube is required in many ear diseases, spontaneous removal of conventional ventilation tube is observed in patients within 3 to 12 mo. To address this issue, we aimed to determine a new method for long-term retention of the ventilation tube.
AIM To explore the value of removing the biofilm for long-term retention of tympanostomy ventilation tubes.
METHODS A case-control study design was used to evaluate the safety and effectiveness of long-term tube retention by directly removing the biofilm (via surgical exfoliation) in patients who underwent myringotomy with ventilation tube placement. The patients were randomly divided into two groups: Control group and treatment group. Patients in the treatment group underwent regular biofilm exfoliation surgery in the clinic, whereas those in the control group did not have their biofilm removed. Only conventional ventilation tubes were placed in this study. Outcome measures were tube position and patency. Tube retention time and any complications were documented.
RESULTS Eight patients with biofilm removal and eight patients without biofilm removal as a control group were enrolled in the study. The tympanostomy tube retention time was significantly longer in the treatment group (43.5 ± 26.4 mo) than in the control group (9.5 ± 6.9 mo) (P = 0.003). More tympanostomy tubes were found to be patent and in correct position in the treatment group during the follow-up intervals than in the control group (P = 0.01).
CONCLUSION Despite the use of short-term ventilation tubes, direct biofilm removal can be a well-tolerated and effective treatment for long-term tube retention of tympanostomy ventilation tubes in patients who underwent myringotomy.
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Affiliation(s)
- Qiang Ma
- Department of Otorhinolaryngology–Head & Neck Surgery, the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
| | - Hui Wang
- Department of Otorhinolaryngology–Head & Neck Surgery, the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
| | - Zheng-Nong Chen
- Department of Otorhinolaryngology–Head & Neck Surgery, the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
| | - Ya-Qin Wu
- Department of Otorhinolaryngology–Head & Neck Surgery, the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
| | - Dong-Zhen Yu
- Department of Otorhinolaryngology–Head & Neck Surgery, the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
| | - Peng-Jun Wang
- Department of Otorhinolaryngology–Head & Neck Surgery, the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
| | - Hai-Bo Shi
- Department of Otorhinolaryngology–Head & Neck Surgery, the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai 200233, China
| | - Kai-Ming Su
- Department of Otorhinolaryngology–Head & Neck Surgery, the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
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Jin M, Sun K, Li X. Comparison of tympanostomy tubes for endoscopic placement in adults with otitis media with effusion. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2019. [DOI: 10.1016/j.lers.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Li YQ, Chen YB, Yin GD, Zeng XL. Effect of balloon dilation eustachian tuboplasty combined with tympanic tube insertion in the treatment of chronic recurrent secretory otitis media. Eur Arch Otorhinolaryngol 2019; 276:2715-2720. [PMID: 31197531 DOI: 10.1007/s00405-019-05512-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/08/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the long-term clinical effect of balloon dilation eustachian tuboplasty (BET) combined with tympanic tube insertion (TTI) in the treatment of chronic recurrent secretory otitis media (CRSOM). MATERIALS AND METHODS A retrospective study of 30 cases of CRSOM treated with BET combined with TTI under general anesthesia between August 2014 and September 2016. Thirty cases of CRSOM treated with TTI in the same period were taken as the control group. All cases were followed over 24 months. The scores of eustachian tube (ET) function preoperation, 1 month, 6 months, 12 months, and 24 months postoperation were collected and analyzed, respectively. A satisfaction questionnaire was used to evaluate the therapy at 24-months postoperation. RESULTS The symptoms were significantly improved and the ET score was obviously increased postsurgery in most cases treated with BET plus TTI compared with those treated with TTI alone. The highest ET score was obtained at 6 months post BET. Five (14%) cases (6 ears) of CRSOM recurred. The 24-month postoperation follow-up questionnaire showed that 84.6% of the patients were satisfied with the treatment, while ten cases (25%) in the TTI group recurred. CONCLUSION BET combined with TTI surgery is an effective therapy for patients with CRSOM.
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Affiliation(s)
- Yong-Qi Li
- Department of Otolaryngology Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China.
| | - Yu-Bin Chen
- Department of Otolaryngology Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Gen-di Yin
- Department of Otolaryngology Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Xiang-Li Zeng
- Department of Otolaryngology Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
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Compare two surgical interventions for otitis media with effusion in young children. Eur Arch Otorhinolaryngol 2019; 276:2125-2131. [DOI: 10.1007/s00405-019-05421-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/07/2019] [Indexed: 11/27/2022]
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18
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Analysis of factors associated with multiple ventilation tube insertions in children with otitis media with effusion. The Journal of Laryngology & Otology 2019; 133:281-284. [DOI: 10.1017/s0022215119000495] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo determine the factors related to multiple ventilation tube insertions in children with otitis media with effusion.MethodsA retrospective review was performed of 126 ears of 81 children aged less than 12 years who had undergone insertion of a Paparella type 1 ventilation tube for the first time between August 2012 and March 2018.ResultsMean age at the first operation was 4.0 ± 2.2 years, and the mean duration of otitis media with effusion before the first ventilation tube insertion was 5.4 ± 4.5 months. Among 126 ears, 80 (63.5 per cent) had a single ventilation tube insertion and 46 (36.5 per cent) had multiple insertions. On multivariate logistic regression, tympanic membrane retraction, serous middle-ear discharge, and early recurrence of otitis media with effusion were independent predictive factors of multiple ventilation tube insertions.ConclusionTympanic membrane retraction, serous middle-ear discharge, and early recurrence of otitis media with effusion after the first tube extrusion are associated with multiple ventilation tube insertions.
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Johnston J, Hoggard M, Biswas K, Astudillo-García C, Radcliff FJ, Mahadevan M, Douglas RG. Pathogen reservoir hypothesis investigated by analyses of the adenotonsillar and middle ear microbiota. Int J Pediatr Otorhinolaryngol 2019; 118:103-109. [PMID: 30599284 DOI: 10.1016/j.ijporl.2018.12.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Adenotonsillar and middle ear diseases result in some of the most frequently performed operations in the pediatric population worldwide. The pathogen reservoir hypothesis (PRH) suggests that the adenoids act as a reservoir of bacteria which play a potential pathogenic role in otitis media. Evidence supporting this hypothesis is limited. This study sought to comprehensively determine and compare associations between the adenotonsillar and middle ear bacterial microbiota within individual patients via next-generation sequencing and microbial network analyses. METHODS Bacterial 16S rRNA gene-targeted amplicon sequencing was used to determine the bacterial composition of ten pediatric patients undergoing adenotonsillectomy and ventilation tube insertion for otitis media with effusion. At the time of surgery, swabs were taken from the adenoid surface, tonsil crypts and middle ear clefts (through the myringotomy incision). RESULTS The most abundant sequences within the bacterial community at genus level across all anatomical sites were Fusobacterium, Haemophilus, Neisseria, and Porphyromonas. There was an observable difference in the relative abundance of bacterial communities, with a higher proportion of Haemophilus and Moraxella in the adenoid when compared with the middle ear. Furthermore, only one module (consisting of 4 bacterial OTUs) from one patient was identified through microbial network analyses to be significantly associated between middle ear and adenoid. In addition, microbial network analysis revealed that the adenoid and tonsil microbiota share greater similarity than do the adenoid and middle ear. CONCLUSION The results of this study suggest that the adenoid microenvironment does not correlate to the middle ear microenvironment. A future study at the species level, and over time, is required to further investigate whether the differing relationship between the microbiota of the adenoid and middle ear rejects the pathogen reservoir hypothesis.
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Affiliation(s)
- James Johnston
- Department of Surgery, The University of Auckland, Auckland, New Zealand.
| | - Michael Hoggard
- School of Biological Sciences, The University of Auckland, Auckland, New Zealand
| | - Kristi Biswas
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | | | - Fiona J Radcliff
- Department of Molecular Medicine and Pathology, The University of Auckland, Auckland, New Zealand
| | - Murali Mahadevan
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Richard G Douglas
- Department of Surgery, The University of Auckland, Auckland, New Zealand
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Si Y, Chen YB, Chu YG, Chen SJ, Xiong H, Chen XM, He WH, Zheng YQ, Zhang ZG. Effects of combination of balloon Eustachian tuboplasty with methylprednisolone irrigation on treatment of chronic otitis media with effusion in adults. Am J Otolaryngol 2018; 39:670-675. [PMID: 30031627 DOI: 10.1016/j.amjoto.2018.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 06/19/2018] [Accepted: 06/22/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE Adult chronic otitis media with effusion (COME) is characterized by Eustachian tube dysfunction and mucosal inflammation, which management has long been a challenge because of high recurrence. This study was to investigate the pathological changes of Eustachian tube mucosa and optimized treatment. MATERIALS AND METHODS Retrospective study of four groups: I: tympanic paracentesis, II: balloon Eustachian tuboplasty (BET), III: BET plus tympanic paracentesis, IV: BET and tympanic paracentesis with methylprednisolone irrigation. Biopsy of Eustachian tube mucosa was obtained preoperative and 1 month post. Recurrence ratio and Eustachian tube scores (ETS) were used to evaluate the effect of treatments. RESULTS All patients showed narrowed with edematous and thickened Eustachian tube mucosa. At 1 month post-treatment, BET with methylprednisolone irrigation significantly decreased intraepithelial inflammation and restored the quality of epithelium and cilia. For group II to IV, The recurrence rate was significantly lower in group IV compared with the other two, but only significantly lower in group IV VS group II at 3 months and 6 months, no significant difference at 12 months. The recurrence rate was significantly higher in group I during follow-up. The ETS were improved in group II, III and IV after treatment. At 1 month and 3 months posttreatment, group IV had significant higher ETS compared with other groups (P < 0.05). There was no serious complications occurred. CONCLUSION Methylprednisolone irrigation could help to recover mucosal function. BET and tympanic paracentesis with methylprednisolone irrigation could be regarded as a good choice for COME in adults, which has less recurrence rate and prompt recovery of ET function.
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Alvi SA, Jones JW, Porter P, Perryman M, Nelson K, Francis CL, Larsen CG. Steroid Versus Antibiotic Drops in the Prevention of Postoperative Myringotomy Tube Complications. Ann Otol Rhinol Laryngol 2018; 127:445-449. [DOI: 10.1177/0003489418776669] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To determine the incidence of early postoperative tympanostomy tube insertion otorrhea and obstruction in pediatric patients receiving antibiotic ear drops with or without steroid perioperatively. Methods: A retrospective chart review was performed on patients who underwent outpatient myringotomy and tube placement. Patients from June 2013 to February 2014 received ciprofloxacin/dexamethasone perioperatively while patients from May 2014 to April 2015 received ofloxacin. Statistical analysis was performed to compare outcomes between the cohorts. Results: One hundred thirty-four patients received topical ciprofloxacin/dexamethasone, and 116 patients received topical ofloxacin. The rate of postoperative otorrhea was 5.2% for the ciprofloxacin/dexamethasone group and 8.2% for the ofloxacin group. Tube obstruction was seen in 6.0% of the ciprofloxacin/dexamethasone group and 5.2% in the ofloxacin group. Neither outcome had a statistically significant difference ( P = .21 and .85, respectively). There was no difference in the rate of effusion at the time of tube placement between the 2 cohorts ( P = .16), and this included subgroup analysis based on effusion type (mucoid, purulent, serous). Patients with a mucoid effusion at the time of surgery were more likely to experience otorrhea/obstruction than patients with dry ears (odds ratio = 2.23, P = .02). Conclusion: No significant difference in the incidence of immediate postoperative tympanostomy tube otorrhea or obstruction was seen between the antibiotic-steroid and antibiotic alone cohorts, regardless of effusion type. Overall, patients with mucoid effusions are more likely to develop tube otorrhea or obstruction at follow-up. Cost-effective drops should be used when prescribing topical therapy to prevent complications after ear tubes.
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Affiliation(s)
- Sameer A. Alvi
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Joel W. Jones
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Paul Porter
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mollie Perryman
- Univerity of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Karen Nelson
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Carrie L. Francis
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Christopher G. Larsen
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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Klopp-Dutote N, Kolski C, Strunski V, Page C. Tympanostomy tubes for serous otitis media and risk of recurrences. Int J Pediatr Otorhinolaryngol 2018; 106:105-109. [PMID: 29447881 DOI: 10.1016/j.ijporl.2018.01.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/05/2018] [Accepted: 01/10/2018] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To determine the value of tympanostomy tubes (TTs) in the management of serous otitis media (SOM) and the risk factors for SOM recurrence. METHOD This single-centre cohort study was performed in the University hospital of Amiens, France; and concerned 215 under-12 children having undergone at least one bilateral TT (Shepard grommet-type) placements for SOM. RESULTS The mean TT retention time was 10 months. SOM recurred in 79 children (62.79%) and thus required a second TT placement (bilaterally in 90% of these cases). Overall, 29.3% of the patients underwent a total of two TT placements, 5.58% underwent three placements and 0.93% underwent four placements. After their first-ever TT placement, 17 children had complications: 10 cases of otorrhoea (4.6%), 4 cases of retraction pocket (1.9%) and 3 perforations of the tympanic membrane (1.4%). At last follow-up, the most common complications were tympanosclerosis (6.9%) and perforation of the tympanic membrane (6.5%). In a multivariate analysis, the only significant risk factors for SOM recurrence were age below 48 months at the time of TT placement, and a TT retention time below 9 months. In contrast, a history of allergy, gastro-oesophageal reflux, prematurity or passive smoking were not significantly associated with recurrence. CONCLUSION Age at the time of TT placement and the TT retention time were significantly associated with SOM recurrence. The TT retention time and the number of TT placements were not associated with the risk of long-term complications.
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Affiliation(s)
| | - Catherine Kolski
- ENT and Head & Neck Surgery Department, Amiens University Hospital, France
| | - Vladimir Strunski
- ENT and Head & Neck Surgery Department, Amiens University Hospital, France
| | - Cyril Page
- ENT and Head & Neck Surgery Department, Amiens University Hospital, France.
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Abdel-NabyAwad OG. Timing for Removal of Asymptomatic Long-Term Ventilation Tube in Children. Indian J Otolaryngol Head Neck Surg 2016; 68:406-412. [PMID: 27833863 PMCID: PMC5083639 DOI: 10.1007/s12070-015-0843-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/13/2015] [Indexed: 11/29/2022] Open
Abstract
Otitis media with effusion (OME) is the most frequent illness in children. Surgical treatment options include ventilation tube insertion, adenoidectomy or both. Opinions regarding the risks, benefits and intubation period of ventilation tube insertion vary greatly. To determine the appropriate time for when to remove asymptomatic longterm ventilation T-tubes in children. In this prospective study, we analyzed the results of 120 pediatric patients (6-12 years) (240 ears) with persistent OME; we employed the Goode T-silicone tubes. We intentionally planned to remove the tubes at different time points of the study and divided our patients randomly into four subgroups with 30 patents (60 ears in each) according to the intubation period; group I: intubation for 6 months, group II: intubation for 12 months, group III: intubation for 18 months and group IV: intubation for 24 months. The relationship between intubation period and OME recurrence, the rate of persistent tympanic membrane (TM) perforation, granulation tissue or discharge near the tympanostomy tubes, normalization of Eustachian tube function and change of hearing level was analyzed in each patient group. The χ2 analysis showed that the rate of normalization of ET function was significantly higher when tubes were removed after 12-months of intubation (P = 0.002), the rate of OME recurrence was significantly higher when tubes were removed before 12-months of intubation (P = 0.004), The rate of otorrhea significantly increased after 12-months of intubation, development of granulation around tubes was significantly higher after 18-months of tube insertion. The rate of appearance of permanent TM perforation significantly increased after 18-months from tube insertion (P = 0.008). Adenoidectomy did not significantly influence the recurrence rate of OME or the rate of persistent TM peroration after tube removal. Our present results suggest that the appropriate intubation period for healing OME in children would be at 12-18 months. Also, we can conclude that longterm ventilation tubes are recommended to avoid repeated intubation and to obtain sufficient results, although their performance is not always satisfactory; mainly because of accompanying complications.
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Affiliation(s)
- Osama G. Abdel-NabyAwad
- Otolaryngology, Head and Neck Surgery Department, Minia University, 122 Kornish El-Neel Street, Minia City, Minia Egypt
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Bhutta MF, Cheeseman MT, Brown SDM. Myringotomy in the Junbo mouse model of chronic otitis media alleviates inflammation and cellular hypoxia. Laryngoscope 2014; 124:E377-83. [PMID: 24706577 DOI: 10.1002/lary.24698] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 03/14/2014] [Accepted: 04/01/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVES/HYPOTHESIS Ventilation of the chronically inflamed middle ear is a key outcome in functional middle ear surgery. Grommets eliminate middle ear effusion, but there is also evidence that they downregulate inflammation. The reason for this is not understood, but there is little to suggest alteration in eustachian tube ventilatory capacity. Previous work has shown that the Junbo mouse model of chronic otitis media has hypoxic middle ear mucosa and bulla fluid leucocytes. Here we explore whether surgical ventilation may alleviate chronic otitis media through downregulation of hypoxia. STUDY DESIGN Surgical intervention on a mouse model of disease. METHODS We established patency of myringotomy incision as 5 days in wild-type mice. We performed unilateral myringotomy on three cohorts of mice: 10 wild-type controls, 12 Junbo mice, and 15 Junbo mice with additional removal of middle ear effusion. A small cohort of these mice were labeled in vivo by intraperitoneal injection of pimonidazole to identify tissue hypoxia. Tissues were assessed for mucoperiosteal thickening and pimonidazole labeling, comparing operated to nonoperated ears. RESULTS Ventilation of the inflamed Junbo middle ear revealed significant reduction in inflammatory thickening associated with loss of pimonidazole labeling, suggesting resolution of cellular hypoxia. CONCLUSIONS Surgical ventilation may achieve therapeutic effect through alleviation of cellular hypoxia in the chronically inflamed middle ear. Targeted molecular therapy of hypoxia signaling may offer future alternative therapy for chronic otitis media.
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Affiliation(s)
- Mahmood F Bhutta
- UCL Ear Institute, London, United Kingdom; MRC Harwell, Harwell Science and Innovation Campus, Oxfordshire, United Kingdom; Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom; Department of Otolaryngology, Barts Health NHS Trust, London, United Kingdom
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Mandel EM, Swarts JD, Casselbrant ML, Tekely KK, Richert BC, Seroky JT, Doyle WJ. Eustachian tube function as a predictor of the recurrence of middle ear effusion in children. Laryngoscope 2013; 123:2285-90. [PMID: 23575552 DOI: 10.1002/lary.24021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 11/29/2012] [Accepted: 01/07/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS In children with ventilation tubes (VTs) inserted for chronic otitis media with effusion (COME), the authors sought to determine whether any parameter of Eustachian tube (ET) function measured by the forced response test (FRT) predicts disease recurrence after the VT becomes nonfunctional. STUDY DESIGN Prospective study of those factors that predict disease recurrence in children with VTs inserted for COME. METHODS Forty-nine subjects (73 ears; 28 male, 34 white, aged 5.3 ± 1.2 years) with COME had VTs inserted and were evaluable for disease status after the VT(s) became nonfunctional. The FRT was done when the VTs were patent, and results for the last test before the VT became nonfunctional were used in the analysis. After each VT became nonfunctional, the children were followed for disease recurrence over a 12-month period. Logistic regression was used to determine whether the ET opening pressure, closing pressure, and/or dilatory efficiency predicted disease recurrence. That model was expanded to include age, sex, race, history of adenoidectomy, previous VTs, and duration of VT patency as potential predictive factors. RESULTS Twenty-nine (40%) ears had recurrence of significant disease within 12 months after the VT became nonfunctional. For the complete logistic regression model, male gender (P = .03), nonwhite race (P = .02), shorter period of VT patency (P = .01), and low dilatory efficiency (P = .01) were significant predictors of disease recurrence. CONCLUSIONS A measure of active ET function, dilatory efficiency, but not measures of passive function predicted disease recurrence within the 12 months after the VT became nonfunctional in children with COME.
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Affiliation(s)
- Ellen M Mandel
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
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When should retained Paparella type I tympanostomy tubes be removed in asymptomatic children? Auris Nasus Larynx 2013; 40:150-3. [DOI: 10.1016/j.anl.2012.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 03/30/2012] [Accepted: 06/29/2012] [Indexed: 11/21/2022]
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Dodson KM, Cohen RS, Rubin BK. Middle ear fluid characteristics in pediatric otitis media with effusion. Int J Pediatr Otorhinolaryngol 2012; 76:1806-9. [PMID: 23021526 DOI: 10.1016/j.ijporl.2012.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 08/27/2012] [Accepted: 09/03/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Persistent otitis media with effusion is caused by poor clearance of middle ear fluid usually following an episode of acute otitis media. This fluid is thought to be viscous and poorly transportable by cilia. Because a subset of children require multiple myringotomy and tube placements for recurrent disease, we hypothesized that children requiring repeated procedures would have effusion fluid that was more viscous and less transportable than those having their first procedure. DESIGN Prospective clinical study. SETTING Tertiary care center. PATIENTS AND INTERVENTIONS Middle ear secretions were collected at the time of myringotomy and tube insertion in 36 children accrued sequentially. Twenty-six of these children were having their first procedure and 10 had previously undergone myringotomy and tube placement. MAIN OUTCOME MEASURES The secretions were evaluated for in vitro mucociliary transportability, and dynamic rheology in a magnetic microrheometer. RESULTS Children with the need for repeated procedures had effusions with lower mucociliary transportability, and overall higher mean measures of surface mechanical impedance/frictional adhesion, but these did not reach statistical significance. Mucopurulent effusions had significantly greater transportability than both the mucoid and serous effusions in both groups. CONCLUSIONS Persistent or recurrent otitis media with effusion is associated with poorly transportable middle ear fluid, which may have higher frictional adhesion. The best mucociliary transportability was measured in mucopurulent effusions.
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Affiliation(s)
- Kelley M Dodson
- Department of Otolaryngology, Virginia Commonwealth University, Richmond, VA, United States.
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