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Otological and audiological outcomes five years after tympanostomy in early childhood
Hannu J Valtonen1, Yrjö H Qvarnberg, Juhani Nuutinen
1Department of Otorhinolaryngology, Kuopio University Hospital, Finland. hannu.valtonen@kuh.fi
Insights
Early ventilation tube treatment for otitis media in young children showed well-preserved hearing, with adverse outcomes comparable to older children. Long-term follow-up is crucial for persistent middle ear issues.
Area of Science:
- Otolaryngology
- Pediatric Medicine
- Audiology
Background:
- The efficacy of ventilation tubes for treating otitis media in young children is debated.
- Limited long-term studies exist for children under one year old.
Purpose of the Study:
- To assess long-term otological and audiological outcomes in children under 17 months treated early with ventilation tubes for recurrent acute otitis media and otitis media with effusion.
Main Methods:
- Prospective follow-up of 281 children for 5 years after primary tympanostomy.
- Evaluations included pneumatic otoscopy, otomicroscopy, and pure-tone audiometry.
Main Results:
- 67.3% of ears healed; 7.1% and 9.6% had pars flaccida and pars tensa tympanic membrane retractions, respectively.
- Ongoing otitis media with effusion (7.5%) and tympanic membrane perforations (4.6%) were observed.
- Mild conductive hearing loss was associated with perforations and retractions.
Conclusions:
- Hearing was generally well-preserved, with no cases of adhesive otitis media or cholesteatoma.
- Adverse outcomes did not exceed those in older children treated with ventilation tubes.
- One-third of ears had persistent middle ear disease or sequelae, highlighting the need for proper follow-up and potential repeat ventilation tube insertion.
Objective:
Ventilation tubes in the treatment of otitis media in young children remain controversial. Despite abundant research, few prospective long-term follow-up studies have included even a minority of patients under 1 year old. We investigated long-term otological and audiological outcomes in children with recurrent acute otitis media and otitis media with effusion, who were treated early with ventilation tubes.
Study Design:
Prospective follow-up.
Methods:
Three hundred five children under 17 months of age received a primary tympanostomy in the Central Hospital of Central Finland (Jyväskylä, Finland), and those 281 (92.1%) who were monitored prospectively for 5 years made up the study group. At the final examination, pneumatic otoscope and otomicroscope were used and pure-tone audiometric thresholds of air and bone conduction were measured to define the hearing levels (mean of 0.5, 1.0, and 2.0 KHz thresholds).
Results:
Of ears, 67.3% were healed, 7.1% had a retraction of tympanic membrane in pars flaccida and 9.6% in pars tensa, 7.5% had an ongoing otitis media with effusion, 3.9% had a ventilation tube in place, and 4.6% had a tympanic membrane perforation with mean hearing levels of 7.6, 9.0, 16.0, 18.5, 10.5, and 17.7 dB, respectively.
Conclusions:
Hearing in general was well preserved, and no ear presented with adhesive otitis media or cholesteatoma. Adverse otological and audiological outcomes of these young children did not exceed those presented by others for older counterparts. Tympanic membrane perforations, ongoing otitis media with effusion, and pars tensa retractions were causes of mild conductive hearing loss. Because one third of ears continued to have middle ear disease or sequelae, we emphasize the proper follow-up and restoration of middle ear ventilation with repeat ventilation tubes if not otherwise achieved.
