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Published on: October 11, 2024
Follow-up audiometry after bilateral myringotomy and tympanostomy tube insertion
Shirley Hu1, Neha A Patel2, Shai Shinhar2
1Department of Otolaryngology, New York Medical College, Valhalla, NY, United States.
Insights
Audiometric testing after tympanostomy tube insertion shows progressive hearing improvement up to 6-10 weeks post-surgery. Early audiometry may underestimate hearing gains in children with otitis media with effusion.
Area of Science:
- Pediatric Otolaryngology
- Audiology
- Evidence-Based Medicine
Background:
- Tympanostomy tube insertion is a common procedure for otitis media with effusion in children.
- Current guidelines for postoperative audiometric follow-up timing are lacking.
- Physician practices for follow-up timing vary significantly.
Purpose of the Study:
- To establish evidence-based recommendations for the timing of postoperative audiograms.
- To guide clinical practice using objective data on hearing improvement after tympanostomy tube insertion.
- To determine the optimal interval for assessing hearing outcomes.
Main Methods:
- Retrospective chart review of pediatric patients undergoing tympanostomy tube insertion.
- Analysis of audiometric data from two postoperative follow-up times.
- Classification of patients based on audiometry type and concurrent procedures (adenotonsillectomy).
Main Results:
- Significant hearing improvement was observed between 2 weeks and 6-10 weeks post-surgery for both sound field and pure-tone audiometry.
- Mean sound field threshold improved from 29.2 dB to 17.9 dB.
- Mean air-bone gap improved from 20.1 dB to 7.3 dB.
- Hearing gains remained significant even with concurrent adenotonsillectomy.
Conclusions:
- Hearing function progressively improves for 6-10 weeks after tympanostomy tube insertion.
- Audiometric testing should be performed no earlier than 6 weeks post-insertion.
- Testing earlier than 6 weeks may lead to an underestimation of hearing improvement.
Objective:
There are no evidence-based guidelines regarding timing of postoperative audiometric follow-up for children undergoing tympanostomy tube insertion. Given the variability of follow-up among physicians, we attempt to guide the timing of postoperative audiograms using objective data.
Study Design:
Retrospective chart review.
Methods:
All pediatric patients undergoing primary bilateral myringotomy and tympanostomy tube insertion for otitis media with effusion who had audiometric data available at two follow-up times were identified from 2014. Patients were classified according to the type of audiometry performed and were further categorized into those who had tympanostomy tube insertion only and those who had concurrent adenotonsillectomies.
Results:
34 patients were included in the study. Among patients assessed by sound field audiometry, the mean sound field threshold value was 29.2dB preoperatively and improved to 21dB 2 weeks postoperatively and 17.9dB 6 to 10 weeks postoperatively. The difference between the two postoperative means was significant (p<0.0001). For patients evaluated by pure-tone audiometry, the mean preoperative air-bone gap was 20.1dB; this improved to 10dB at the first postoperative visit and 7.3dB at the second visit. The difference between the two means was significant (p<0.0001). For the subgroups in which adjunct adenotonsillectomy was performed, the greater improvement at the later follow-up was still statistically significant.
Conclusions:
Progressive hearing improvement was demonstrated from 2 weeks to 6 to 10 weeks postoperatively. We recommend testing no fewer than 6 weeks after tympanostomy tube insertion. Earlier audiometry underestimates the degree of hearing improvement.
