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Published on: January 27, 2010
Pre-operative prediction of 'dry taps'
1Department of Otolaryngology Head & Neck Surgery, Cumberland Infirmary, Carlisle, UK. scott.henney@doctors.org.uk
Insights
A dry tap during myringotomy for glue ear in children is often predicted by non-type B tympanometry and surgical delays. This finding helps surgeons anticipate cases where no middle ear fluid is found.
Area of Science:
- Pediatric Otolaryngology
- Anesthesiology in Otologic Surgery
Background:
- 'Glue ear' (otitis media with effusion) management involves myringotomy and grommet insertion.
- Surgeons face uncertainty when myringotomy yields no middle ear fluid (a 'dry tap').
Purpose of the Study:
- To identify factors predicting a 'dry tap' during myringotomy in children.
- To improve surgical decision-making in pediatric otitis media with effusion.
Main Methods:
- Prospective cohort study of 280 children (504 myringotomies).
- Data collected: pre- and post-induction tympanometry, age, season, anesthetic type (halothane/nitrous oxide vs. enflurane), and delay from listing to operation.
- Myringotomy outcomes (fluid presence or 'dry tap') were documented.
Main Results:
- A 'dry tap' occurred in 18% of myringotomies.
- Non-type B pre-induction tympanometry and longer delays to operation were significant predictors of a 'dry tap'.
- Anesthesia induction was rarely the cause of a 'dry tap'.
Conclusions:
- Non-type B tympanometry and surgical delay are key indicators for predicting 'dry taps' in pediatric myringotomy.
- These findings can help optimize surgical planning and resource allocation.
- Understanding 'dry tap' predictors aids in managing children with otitis media with effusion.
Objectives:
The treatment of children with 'glue ear' often presents surgeons with the question of whether or not to insert a grommet when myringotomy reveals no fluid in the middle ear. We present a study designed to assess which factors contribute to the presence of a 'dry tap'.
Design:
We prospectively gathered data from a cohort of 280 children (504 myringotomies). The cohort included two subgroups, one received halothane and nitrous oxide anaesthesia, and the other received enflurane anaesthesia.
Setting:
The ENT department of a district general hospital.
Participants:
Children (aged less than 17 years) requiring myringotomy.
Main Outcome Measures:
The presence of a 'glue' or dry tap at myringotomy was documented. We also recorded data on the following: pre- and post-induction tympanometry; age; season; anaesthetic type; and the delay from listing to actual operation.
Results:
A non type B pre-induction tympanogram and delay to operation were strong indications of finding a dry tap at surgery.
Conclusions:
In our study population, the proportion of dry taps at myringotomy was 18 per cent. The presence of a dry tap was rarely due to the induction of anaesthesia. Multivariate analysis revealed that the combination of factors most likely to predict a dry tap were non type B tympanogram and delay to operation.
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