Serous otitis media in the 20th and 21st centuries: evolving views and treatments

Collaborative working between pediatric speech and language therapy and ENT colleagues: what is good practice?

PURPOSE OF REVIEW

This article considers current evidence pertaining to good practice in joint paediatric speech and language therapy (SLT) and ear, nose and throat (ENT) assessment and management in the general hospital clinic. Because of space limitations, this review excludes those cases that are typically referred into highly specialist clinics dealing with cleft palate or profound hearing loss and cochlear implant. It will instead focus on children with the types of communication difficulties that are related to physical anomalies and conditions impacting on speech, nasal resonance, voice and those cases with a history of fluctuating or mild hearing loss. The value of the multidisciplinary team in appropriate decision making has to be considered in terms of outcomes and related cost-effectiveness.

RECENT FINDINGS

Research into the dynamic between paediatric ENT and SLT outcomes remains relatively sparse. Evidence continues to show that multiple factors impact on any decision regarding surgical or SLT interventions. SLT opinion across a range of perceptual, physical and social parameters aids the medical consultation on a case-by-case basis. Current evidence for speech therapy interventions shows that environmental management and family involvement are crucial, and any direct intervention should be well timed and regular to be effective.

SUMMARY

The development of communication and listening is easily disrupted because of ENT disease or abnormality. The child's relationship with the ENT consultant and SLT may span several years, and communication difficulties may persist after any apparent physical problem has resolved. It is essential to jointly consider the optimum timing for any surgical and speech interventions so that services are better targeted and cost-effective.

Transmyringeal ventilation tube treatment: a 10-year cohort study

OBJECTIVE

This ten-year cohort study was intended to determine the incidence and expected outcome of ventilation tube treatment at a clinic that serves a community with 300,000 inhabitants.

METHODS

All children aged 0-10 years, who received their first ventilation tube during 1996, were followed over 10 years, at the department of Otorhinolaryngology, county hospital Ryhov, Jönköping, Sweden. All acute and planned visits were recorded and analyzed, but no extra visits were scheduled due to participation in the study.

RESULTS

In 1996 the overall incidence of tube insertion in the age group 0-10 years was 1 percent. A total of 155 children were entered, and 146 (94 percent) fulfilled the study. During the 10 years' follow up, a total of 409 acute visits and 1485 planned visits were made. In approximately 50 percent of the cases the first ventilation tube was still in place after one year. Infection occurred in 53 percent of the treated ear(s) at least once; the risk for infection was higher if the indication for ventilation tube placement was recurrent acute otitis media. In 45 percent of the children at least one more tube insertion was needed. A permanent perforation after tube treatment was seen in 2 percent of the treated ears. After 5 years, one half of the children were declared free from middle ear disease, but at the termination of the study 17 percent of the children were still in need of regular visits to an otologist due to residual ear problems.

CONCLUSION

This study shows the natural course of treatment with middle ear ventilation tubes in a cohort of children aged 0-10 years during a ten-year period. The incidence of ventilation tube treatment was 1 percent. It is evident that many children need a prolonged contact with an ear-nose and throat specialist when treated with a ventilation tube.

Modifiable determinants of hearing impairment in adults

OBJECTIVE

To identify factors contributing to the declining prevalence of hearing impairment in more recent generations.

METHODS

We used data on hearing thresholds and potential risk factors of hearing impairment collected from studies in Beaver Dam, Wisconsin, the Epidemiology of Hearing Loss Study (1993-1995, n=3753; 1998-2000, n=2800 and 2003-2005, n=2395), the concurrent Beaver Dam Eye Study on the same cohort, and a subgroup (n=2173) of the Beaver Dam Offspring Study (2005-2008).

RESULTS

Educational attainment significantly reduced the odds ratio (OR) of the birth cohort effect on hearing impairment from 0.90 to 0.93, while a history of ear infection had a reverse effect on the decreasing trend (significantly changing the OR from 0.93 to 0.94). Occupational noise exposure, smoking, and a history of cardiovascular disease, while associated with hearing impairment, did not attenuate the cohort effect. The cohort effect remained significant after known risk factors were adjusted (OR=0.93; 95% confidence interval, 0.89-0.97).

CONCLUSION

These data provide strong evidence that environmental, lifestyle, or other modifiable factors contribute to the etiology of hearing impairment and add support to the idea that hearing impairment in adults may be prevented or delayed.

Otitis media history, surgery and allergy in 60-year perspective: a population-based study

OBJECTIVES

To assess the relationship between recurrent otitis media (OM), OM surgery and allergy in a 60-years perspective in the general population.

METHODS

A cross-sectional questionnaire study of 40,000 randomly selected Norwegians aged 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75 and 80 years stratified by age and gender in 2005, i.e. each age group 30-60 years included 2000 and the remaining age groups 1000 persons of each gender. Main outcome measures were recurrent childhood OM, childhood myringotomy, ventilation tubes or adenoidectomy and lifetime allergy.

RESULTS

The prevalence of recurrent OM was 24.3% (n=4823) and OM surgery 12.4% (n=2499). An increase in the proportion of OM surgery by age cohort was found, with the highest surgery rate of 0.52 for the 1955 age cohort, followed by a gradual decrease until the 1980 age cohort, when surgery stabilized at 0.42. Recurrent OM and OM surgery was more common in respondents with allergy. Among the latter, the probability for OM surgery was almost threefold when the age cohort 1945 was compared to 1920, OR(adj) at 2.95 (1.59-5.48). The latter tendency remained strong until 1965. Among non-allergics, the increase in surgery probability by age cohort showed the same tendency, but the relationship was less strong than for those with allergy.

CONCLUSIONS

Despite a twofold increase in recurrent OM and OM surgery from 1925 to 1945, the proportion of OM and OM surgery have been stable since 1945. Our findings suggest a shift in clinical practice, most likely indicating a change in surgery from acute infections to otitis media with effusion (OME).