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Persistent conductive or mixed hearing loss after the placement of tympanostomy tubes

Kenneth R Whittemore1, Briana K Dornan, Tara Lally

  • 1Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA 02115, United States. Kenneth.whittemore@childrens.harvard.edu

International Journal of Pediatric Otorhinolaryngology
|July 17, 2012
PubMed

Insights

Persistent hearing loss in children after tympanostomy tube placement can stem from various causes, including anatomical issues and genetic syndromes. Early diagnosis and tailored investigations are key for effective management of pediatric hearing loss.

Area of Science:

  • Pediatric Otolaryngology
  • Audiology
  • Medical Genetics

Background:

  • Serous otitis media is common in children, often treated with tympanostomy tubes.
  • Persistent conductive or mixed hearing loss can occur after tympanostomy tube placement.
  • Understanding the etiology of post-tympanostomy tube hearing loss is crucial for appropriate management.

Purpose of the Study:

  • To describe the clinical findings in children with persistent hearing loss after tympanostomy tube placement.
  • To identify potential causes and diagnostic approaches for this specific patient group.

Main Methods:

  • Retrospective chart review of 39 children with conductive or mixed hearing loss post-tympanostomy tube placement.
  • Review included clinical histories, physical examinations, audiological evaluations, diagnostic studies, and surgical findings.
  • Institutional Review Board approval was obtained from Boston Children's Hospital.

Main Results:

  • Identified causes of hearing loss: ossicular and cochlear abnormalities, 'third window' effects, cholesteatomas, genetic syndromes, and unknown factors.
  • Functional tubes caused isolated mild low-frequency conductive hearing loss in four patients.
  • Bilateral hearing loss was associated with genetic syndromes; mixed hearing loss with cochlear abnormalities, 'third window' effects, or genetic syndromes.
  • Computed tomography (CT) aided diagnosis in 16/25 patients; vestibular-evoked myogenic potential (VEMP) testing suggested diagnosis in 3/4 patients.

Conclusions:

  • Laterality and type of hearing loss are important diagnostic indicators in children with persistent hearing loss post-tympanostomy tube placement.
  • Genetic testing is recommended for patients with bilateral hearing loss due to potential underlying syndromes.
  • Inner ear anomalies should be evaluated in patients with mixed hearing loss; mild, low-frequency hearing loss requires monitoring and further investigation if it progresses.
Abstract

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