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Bellavance S, Khoury M, Fournier I, Costisella J, Lapointe A, Giguère C, Doré-Bergeron MJ, Bergeron M. Tympanostomy Tubes Under Local Versus General Anesthesia for Children: A Prospective Long-Term Study. Laryngoscope 2024. [PMID: 38958053 DOI: 10.1002/lary.31611] [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: 03/19/2024] [Revised: 06/06/2024] [Accepted: 06/17/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVES Tympanostomy tube insertion (TTI) under local anesthesia (LA) is gaining popularity but literature comparing long-term outcomes for children undergoing TTI under LA versus general anesthesia (GA) is limited. This study compares the long-term quality of life (QoL) between LA and GA in children undergoing TTI. Secondary objectives included long-term behavioral changes, parental satisfaction, tube durability, and postoperative complications. METHODS We prospectively followed children aged under 6 who underwent TTI, under LA or GA, 2 years prior. We assessed QoL using validated scales (OM6, PedsQL), analyzed behavioral changes and parental satisfaction through qualitative scales, and retrieved data on tube durability and non-immediate complications. RESULTS A total of 84 children (LA = 42; GA = 42) had complete data and a minimum of 1 year of follow-up. Demographic data were similar, except for younger patients in the LA group (1.4 vs. 1.9 years, p = 0.02). LA group exhibited increased fear of health care professionals following TTI (LA: Likert scale 2.1/5, GA: 1.5/5, p = 0.04). Tube retention rate was shorter in the LA group (at 15 months: GA:72%, LA:50%, p = 0.039). Two years post-TTI, there were no differences regarding QoL (OM-6 score; LA: 15.2/100, GA: 21.4/100, p = 0.18, and PedsQL score; LA: 84.3/100, GA: 83.8/100, p = 0.90), parental satisfaction with anesthesia (GA: 4.5/5, LA: 4.6/5, p = 0.56), and postoperative complications (GA: 3/42, LA: 7/42, p = 0.18). CONCLUSIONS TTI under LA in children is associated with an increased fear of health care professionals and shorter functionality of tympanostomy tubes as compared to GA. No difference was observed in long-term QoL, parental satisfaction, and complications rate. LEVEL OF EVIDENCE Level 3 Laryngoscope, 2024.
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Affiliation(s)
- Samuel Bellavance
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Michel Khoury
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Isabelle Fournier
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Jérôme Costisella
- Faculty of Medecine, Université de Sherbrooke, Sherbrooke, Quebec, 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 Giguère
- 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
- Department of Paediatrics, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, Quebec, Canada
- Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
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Saraf A, Manhas M, Kalsotra P. Assessment of Quality of Life After Ventilation Tube Insertion Using Otitis Media 6-Item (OM-6) Questionnaire. Indian J Otolaryngol Head Neck Surg 2022; 75:97-102. [PMCID: PMC9667446 DOI: 10.1007/s12070-022-03278-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Aditiya Saraf
- Department of ENT and Head and Neck Surgery, SMGS Hospital, Government Medical College Jammu, Jammu and Kashmir, India
| | - Monica Manhas
- Department of Physiology, Government Medical College Jammu, Jammu and Kashmir, India
| | - Parmod Kalsotra
- Department of ENT and Head and Neck Surgery, SMGS Hospital, Government Medical College Jammu, Jammu and Kashmir, India
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Lavere PF, Ohlstein JF, Smith SP, Szeremeta W, Pine HS. Preventing unnecessary tympanostomy tube placement in children. Int J Pediatr Otorhinolaryngol 2019; 122:40-43. [PMID: 30951971 DOI: 10.1016/j.ijporl.2019.03.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/24/2019] [Accepted: 03/26/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE In 2013 the American Academy of Otolaryngology published tympanostomy tube guidelines for children; Action Statement 6 recommends against tube placement without middle ear effusion (MEE) at time of assessment. To date, little research has directly evaluated this recommendation in reducing the need for ear tubes. We evaluated the effectiveness of this recommendation and potential risk factors that influence the success of watchful waiting. METHODS Retrospective chart review collecting demographics, daycare status, smoking exposure, and time of year of visit. Children aged 6 months to 12 years without MEE on presentation, but with 3 or more episodes of acute otitis media (AOM) in 6 months or 4 or more episodes in 12 months, were assigned to watchful waiting (WW) treatment. These patients were followed every 4 months or returned sooner with additional infections. Any continued AOM, or MEE on follow up leading to tube placement, defined WW failure. RESULTS 123 patients met criteria, with 81 still in WW to date (66% success rate). 42 children failed WW and received tympanostomy tubes (34% failure rate). There were no statistically significant associations between age, race, gender, smoking exposure, daycare, or month of presentation between children who failed WW compared to children receiving tubes. CONCLUSIONS Tympanostomy tube guidelines mitigate unnecessary tube placement in a majority of children with recurrent AOM without MEE. To our knowledge, this is the first study supporting the 2013 recommendations, with a 66% success rate. Additionally, no significant associations between modifying risk factors in those who failed watchful waiting were identified.
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Affiliation(s)
- Philip F Lavere
- University of Texas Medical Branch Department of Otolaryngology, 7.104 John Sealy Annex, 301 University Boulevard, Galveston, TX, 77555, USA.
| | - Jason F Ohlstein
- University of Texas Medical Branch Department of Otolaryngology, 7.104 John Sealy Annex, 301 University Boulevard, Galveston, TX, 77555, USA. https://www.utmb.edu/oto/
| | - Steven P Smith
- University of Texas Medical Branch Department of Otolaryngology, 7.104 John Sealy Annex, 301 University Boulevard, Galveston, TX, 77555, USA.
| | - Wasyl Szeremeta
- University of Texas Medical Branch Department of Otolaryngology, 7.104 John Sealy Annex, 301 University Boulevard, Galveston, TX, 77555, USA.
| | - Harold S Pine
- University of Texas Medical Branch Department of Otolaryngology, 7.104 John Sealy Annex, 301 University Boulevard, Galveston, TX, 77555, USA.
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