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Chronic otitis media with effusion sequelae in children treated with tubes
Kathleen A Daly1, Lisa L Hunter, Bruce R Lindgren
1University of Minnesota Otitis Media Research Center, University of Minnesota School of Medicine, USA. dalyx002@umn.edu
Insights
Middle ear sequelae, including atrophy and abnormal tympanometry, are common in children treated for otitis media with effusion. These conditions persist long-term, potentially leading to ongoing ear issues.
Area of Science:
- Otolaryngology
- Pediatric Audiology
- Middle Ear Disease Research
Background:
- Otitis media with effusion (OME) is a common childhood condition requiring treatment.
- Standard treatment involves tympanostomy tubes, but sequelae can arise.
- Long-term outcomes of OME treatment require further investigation.
Purpose of the Study:
- To determine the incidence and prevalence of middle ear sequelae and abnormal tympanometry in children post-tympanostomy tube insertion for OME.
- To assess the long-term development and progression of these middle ear sequelae.
Main Methods:
- Prospective cohort study of 140 children followed for 8 years.
- Evaluated tympanic membrane sequelae (perforation, atrophy, retraction, myringosclerosis) and tympanometry results (static admittance, peak pressure).
- Standard treatment with tympanostomy tubes was administered.
Main Results:
- Annual incidence of sequelae, particularly atrophy and high static admittance with narrow-peaked tympanograms, increased significantly in the first 5 years.
- Prevalence of most sequelae also rose over time, with few ears remaining unaffected by 8 years.
- Sequelae tended to become bilateral, but concordance between different sequelae was low.
Conclusions:
- While the annual incidence of sequelae decreased with age, cumulative effects led to high prevalence by 8 years.
- Functional and morphologic sequelae are common and may predispose children to future middle ear problems.
- Sequelae development is linked to the active phase of OME, with risk decreasing as children mature.
Objective:
To determine incidence and prevalence of middle ear sequelae and abnormal tympanometry results among children with chronic otitis media with effusion (OME) who received standard treatment with tympanostomy tubes.
Design:
Prospective cohort study.
Setting:
Community clinic and academic medical center. Patients A total of 140 children followed up for 8 years after tube treatment.
Main Outcome Measures:
Tympanic membrane perforation, atrophy, retraction, hearing loss, myringosclerosis, low static admittance (SA) and broad-peaked tympanogram, high SA and narrow-peaked tympanogram, and negative tympanometric peak pressure.
Results:
Annual incidence of sequelae was typically greater during 3 to 5 years than 6 to 8 years of follow-up. Greatest increases in incidence during the 5-year follow-up were for atrophy (67%), high SA and narrow-peaked tympanogram (70%), and retraction pocket (47%). Prevalence of these sequelae also increased over time, whereas low SA and broad-peaked tympanogram and negative tympanometric peak pressure decreased during follow-up. Sequela tended to become bilateral over time, and concordance of different sequelae in the same ear was low (kappa, 0.05-0.42).
Conclusions:
Annual incidence of sequelae decreased during follow-up. This finding parallels decreasing incidence of OME and tube placement as children mature and demonstrates that sequelae are more likely to develop during active acute and chronic OME. The cumulative effect of incidence resulted in few ears free of sequelae by 8 years of follow-up. Based on this cohort of healthy children with OME, although the risk of sequelae decreased over time, functional and morphologic sequelae were prevalent and may put children at risk for continuing middle ear problems as they grow into adolescence and adulthood.
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