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Atelectasis of the middle ear in pediatric patients: safety of surgical intervention
Johannes Borgstein1, Tatjana Gerritsma, Iain Bruce
1Sophia Children's Hospital, Erasmus University, Rotterdam, The Netherlands. j.borgstein@erasmusmc.nl
Insights
Early surgical intervention for pediatric middle ear atelectasis improves hearing outcomes across all disease stages. This study found no iatrogenic sensorineural hearing loss, supporting early treatment for pediatric atelectasis.
Area of Science:
- Otolaryngology
- Pediatric Otology
- Audiology
Background:
- There is no consensus on the optimal treatment for pediatric middle ear atelectasis.
- Current practice in our department favors early surgical intervention.
- This study aimed to evaluate the audiological outcomes of early intervention.
Purpose of the Study:
- To assess the safety and efficacy of early surgical intervention for pediatric middle ear atelectasis.
- To analyze audiological outcomes in relation to disease severity.
- To provide evidence supporting or refuting early intervention policies.
Main Methods:
- Retrospective case note review of surgically treated pediatric atelectasis cases.
- Classification of disease severity using the Erasmus Classification of Pediatric Atelectasis.
- Comparison of pre- and postoperative air-conduction (ac) and bone-conduction (bc) thresholds.
Main Results:
- The study included 169 ears from 127 patients, with a mean age of 9.6 years at surgery.
- Significant improvement in average air-bone gap (ABG) was observed across all stages of atelectasis.
- No postoperative deterioration in bone conduction thresholds or instances of 'dead ears' were reported.
Conclusions:
- Surgical intervention positively impacts hearing levels in pediatric middle ear atelectasis, regardless of stage.
- Hearing loss is most severe in stage V atelectasis.
- The findings do not support rejecting early intervention policies due to risks of iatrogenic sensorineural hearing loss.
Objective:
There is no consensus amongst clinicians regarding the best treatment strategy for pediatric atelectasis of the middle ear. It is the policy in our pediatric otolaryngology department to intervene early in the disease process. In an attempt to provide evidence regarding the safety of early intervention we have analyzed the audiological outcome following surgery in different stages of the disease.
Study Design:
Retrospective case note review.
Methods:
We undertook a retrospective study of children with atelectasis treated surgically at a Dutch tertiary referral centre. Disease severity was classified according to the Erasmus Classification of Pediatric Atelectasis, and pre- and postoperative four frequency ac and bc thresholds were compared.
Results:
The study group consisted of 169 ears in 127 patients. The mean age at surgery was 9.6 years. There was an improvement in the average air-bone gap (ABG) for all stages. No deterioration in mean bone conduction thresholds was found following surgical intervention and there were no dead ears postoperatively.
Conclusion:
This study demonstrated that surgical intervention had a favourable effect on hearing level across all stages, though hearing was markedly worse in stage V, and that a policy of intervention early in the disease process cannot be rejected on the grounds of risk of iatrogenic sensorineural hearing loss.
