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Fournier I, Caron C, McMurtry CM, Lapointe A, Giguere C, Doré-Bergeron MJ, Bergeron M. Comparison of Tympanostomy Tubes Under Local Anesthesia Versus General Anesthesia for Children. Laryngoscope 2024; 134:2422-2429. [PMID: 37800866 DOI: 10.1002/lary.31095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE Tympanostomy tube insertion (TTI) is typically accomplished under general anesthesia (GA) in the operating room. We aimed to compare pain between GA and local anesthesia (LA) in surgically naïve children undergoing TTI. Secondary objectives examined patient's quality of life (QoL) and parent's satisfaction. STUDY DESIGN Prospective single-center study. SETTING Tertiary pediatric academic center. METHODS Consecutive children who underwent TTI under GA were compared to patients under LA. Pain standardized observational pain scales (Face, Legs, Activity, Cry, Consolability Scale [FLACC], Children's hospital of Eastern Ontario Pain Scale [CHEOPS]) were completed pre-procedure, during the first tympanostomy and second tympanostomy, and post-procedure, as well as 1 week postoperatively. General health-related QoL (PedsQL) and QoL specific to otitis media (OM-6) were measured before insertion and 1 month postoperatively. Parental satisfaction was also evaluated using a qualitative scale. RESULTS LA group had statistically significant higher pain levels at the beginning (7.3 vs. 0), during the first tympanostomy (7.8 vs. 0), during the second tympanostomy (7.7 vs. 0), and at end of the procedure (6.9 vs. 0) with the FLACC scale (all p < 0.01). Results were similar with the CHEOPS scale. No pain was noted 1 week after surgery in either group. Both groups had similar improvement in their QoL (p > 0.05). Minor complication occurred at a similar rate (p > 0.05). Parents were equally satisfied with their choice of anesthesia in both groups when initially questioned after the procedure (p > 0.05). CONCLUSIONS Children experienced significantly less pain under GA than LA. If LA is to be used, pain and distress-reducing strategies are critical. Shared decision-making with families is essential. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2422-2429, 2024.
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Affiliation(s)
- Isabelle Fournier
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Camille Caron
- Faculty of Medecine, Université de Montréal, Montreal, Quebec, Canada
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
- Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Annie Lapointe
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
- Division of Pediatric Otolaryngology-Head and Neck Surgery, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Chantal Giguere
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
- Division of Pediatric Otolaryngology-Head and Neck Surgery, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Marie-Joëlle Doré-Bergeron
- Department of Paediatrics, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Department of Paediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Mathieu Bergeron
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
- Division of Pediatric Otolaryngology-Head and Neck Surgery, CHU Sainte-Justine, Montreal, Quebec, Canada
- CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, Quebec, Canada
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Heward E, Dempsey J, Molloy J, Isba R, Lunn J, Ashcroft DM, Hay AD, Nichani JR, Bruce IA. Outcome measures for use in trials of paediatric otorrhoea: A systematic review. Int J Pediatr Otorhinolaryngol 2024; 176:111820. [PMID: 38103308 DOI: 10.1016/j.ijporl.2023.111820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/24/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Paediatric otorrhoea (PO) describes a middle ear infection that results in a perforation of the tympanic membrane and ear discharge, in children and young people (CYP). Prolonged infection may be associated with hearing loss and developmental delay. The current management of paediatric otorrhoea is variable, including non-invasive treatments (conservative, oral antibiotics, topical antibiotics) and surgery, reflecting the lack of a sufficiently strong evidence base. Outcome reporting is fundamental to producing reliable and meaningful evidence to inform best practice. OBJECTIVES Primary objective: to determine which outcome measures are currently used to evaluate treatment success in studies of non-surgical treatments for paediatric otorrhoea. SECONDARY OBJECTIVES to identify outcome measurement instruments used in the literature and assess their applicability for use in clinical trials of PO. METHODS This systematic review was registered with PROSPERO (CRD42023407976). Database searches of EMBASE, MEDLINE and Cochrane was performed on June 6, 2023, covering from Jan 1995 to May 2023. Randomised controlled trials or study protocols involving CYP with PO were included following PRISMA guidelines. Risk of bias was assessed with Cochrane's tool. RESULTS Of the 377 papers identified, six were included in the systematic review. The primary outcome of five of the studies related to otorrhoea cessation; both time to cessation and proportion recovered at various time points were used as measures. Two measurement instruments were identified: Otitis Media-6 Questionnaire and the Institute for Medical Technology Assessment Productivity Cost Questionnaire. Both were shown to be applicable measurement instruments when used in clinical trials of PO. CONCLUSIONS To promote homogeneity and facilitate meaningful comparison and combination of studies, we propose that time to cessation of otorrhoea from onset of otorrhoea should be used as the primary outcome in future studies. Further research is needed to establish if this is the most important outcome to children and their caregivers.
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Affiliation(s)
- Elliot Heward
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, UK.
| | - James Dempsey
- Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, UK
| | - John Molloy
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, UK
| | - Rachel Isba
- Alder Hey Children's NHS Foundation Trust, UK
| | - Judith Lunn
- Lancaster Medical School, Lancaster University, Health Innovation One, Sir John Fisher Drive, Lancaster, UK
| | - Darren M Ashcroft
- Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Jaya R Nichani
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, UK
| | - Iain A Bruce
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, UK
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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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Perdrizet J, Farkouh RA, Horn EK, Hayford K, Sings HL, Wasserman MD. The broader impacts of otitis media and sequelae for informing economic evaluations of pneumococcal conjugate vaccines. Expert Rev Vaccines 2022; 21:499-511. [PMID: 35191368 DOI: 10.1080/14760584.2022.2040989] [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: 11/04/2022]
Abstract
INTRODUCTION Otitis media (OM) is a common childhood infection. Pneumococcal conjugate vaccines (PCVs) prevent OM episodes, thereby reducing short- and long-term clinical, economic, humanistic, and societal consequences. Most economic evaluations of PCVs focus on direct health gains and cost savings from prevented acute episodes but do not fully account for the broader societal impacts of OM prevention. AREAS COVERED This review explores the broader burden of OM on children, caregivers, and society to better inform future economic evaluations of PCVs. EXPERT OPINION OM causes a substantial burden to society through long-term sequelae, productivity losses, reduced quality of life for children and caregivers, and contribution to antimicrobial resistance from inappropriate antibiotic use. The effect of PCVs on acute OM has been recognized globally, yet the broader impact has not been consistently quantified, studied, or communicated. Economic evaluations of PCVs must evolve to include broader effects for patients, caregivers, and society from OM prevention. Future PCVs with broader coverage may further reduce OM incidence and antimicrobial resistance, but optimal uptake will depend on increasing the recognition and use of novel frameworks that include broader benefits. Communicating the full value of PCVs to decision makers may result in wider access and positive societal returns.
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Affiliation(s)
- Johnna Perdrizet
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Raymond A Farkouh
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Emily K Horn
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Kyla Hayford
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer, Inc., Toronto, Canada
| | - Heather L Sings
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer, Inc., Collegeville, PA, USA
| | - Matt D Wasserman
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
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Indius JH, Alqaderi SK, Kjeldsen AD, Heidemann CH. Middle ear disease in Danish toddlers attending nursery day-care - Applicability of OM-6, disease specific quality of life and predictors for middle ear symptoms. Int J Pediatr Otorhinolaryngol 2018; 110:130-134. [PMID: 29859574 DOI: 10.1016/j.ijporl.2018.04.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/27/2018] [Accepted: 04/28/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Otitis media (OM) is a very common childhood disease and impacts child quality of life (QoL) to different extends. The aim of this study was to investigate the difference in quality of life between three groups of children; Children with symptoms of ear disease within the last 4 weeks, children without any ear disease and children scheduled for ventilating tube treatment. Furthermore, we investigated predictors for experiencing middle ear symptoms. Lastly, we assessed psychometric properties of OM-6 used to assess QoL. METHODS Four hundred ninety-four children attending nursery day-care aged 6-36 months were enrolled in the study. Caregivers were asked to recall the child's history of symptoms related to middle ear infection. The Danish version of otitis media-6 questionnaire was used to measure the children's quality of life. Data from children treated with ventilating tubes were included from a previously published study. Logistic regression was applied for determining possible predictors for experiencing ear related symptoms. RESULTS The study had an 87% response rate, with a total of 342 children included. At the inclusion 32 (9%) children were included in the 4-week group and, while 307 children were allocated to the non-4 week group. The children in the 4-week group were significantly younger and were more likely to have siblings with a history of middle ear infection than the non-4week group. Furthermore, QoL was significantly worse in the 4-week group compared to the non-4week group. Only subtle differences were found between children with acute symptoms compared to children scheduled for tube treatment. CONCLUSIONS As expected, children with acute symptoms of OM experience lowered QoL compared to children with no symptoms and young age as well as having siblings with a history of middle ear problems were found to be possible predictors for experiencing middle ear symptoms. Children with acute symptoms differed from children scheduled for ventilating tubes on domains related to long-term problems from OM. OM-6 has shown to be a valid instrument for assessing disease specific QoL in children with OM, however a more large-scale instrument might be necessary for detecting subtle differences between subgroups of children with OM.
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Affiliation(s)
- J H Indius
- Department of Otorhinolaryngology-Head and Neck Surgery, Odense University Hospital, Denmark.
| | - S K Alqaderi
- Department of Otorhinolaryngology-Head and Neck Surgery, Odense University Hospital, Denmark
| | - A D Kjeldsen
- Department of Otorhinolaryngology-Head and Neck Surgery, Odense University Hospital, Denmark
| | - C H Heidemann
- Department of Otorhinolaryngology-Head and Neck Surgery, Odense University Hospital, Denmark
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