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A randomised controlled trial of surgery for glue ear
N A Black1, C F Sanderson, A P Freeland
1Department of Public Health and Policy, London School of Hygiene and Tropical Medicine.
BMJ (Clinical Research Ed.)
|June 16, 1990
Summary
Grommet insertion effectively improves hearing in children with glue ear (secretory otitis media) short-term. Adenoidectomy may aid middle ear function but not hearing, with preoperative hearing levels predicting surgical success.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Audiology
Background:
- Glue ear, or secretory otitis media, is a common childhood condition affecting hearing.
- Surgical interventions aim to improve hearing and middle ear function.
Purpose of the Study:
- To evaluate the effectiveness of five surgical treatments for glue ear.
- To determine appropriate indications for surgical intervention.
Main Methods:
- Randomized controlled trial involving 149 children aged 4-9 years.
- Comparison of treatments: adenoidectomy, myringotomy, and grommet insertion (various combinations).
- Follow-up at 7 weeks, 6, 12, and 24 months assessing hearing, tympanometry, and parental reports.
Main Results:
- Grommet insertion provided short-term hearing improvement (up to 6 months) compared to no grommet.
- Hearing benefits diminished by 12 months; adenoidectomy showed sustained, though not significant, hearing improvement.
- Adenoidectomy with grommet insertion improved middle ear function at 2 years compared to grommet alone.
- Preoperative hearing level was the strongest predictor of successful surgical outcome.
Conclusions:
- Grommet insertion is the primary surgical choice for hearing restoration in glue ear.
- Adenoidectomy may enhance middle ear function but does not directly improve hearing.
- Balancing surgical intervention against potential benefits, guided by preoperative audiometry, is crucial for patient selection.