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Long-Term Otitis Media Outcomes in Infants With Early Tympanostomy Tubes
Kimberly Luu1, James Park1, Amber D Shaffer1
1Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Insights
Infants failing newborn hearing screens often need early tympanostomy tubes for ear fluid. Many experience recurrent ear infections and require additional tubes, highlighting the importance of ongoing hearing monitoring.
Area of Science:
- Pediatric Otolaryngology
- Audiology
- Neonatal Care
Background:
- Otitis media with effusion (OME) frequently causes failures in newborn hearing screens (NBHS).
- Early tympanostomy tube insertion is sometimes necessary for infants with OME.
- The long-term otologic outcomes for these infants require further investigation.
Purpose of the Study:
- To evaluate the otologic outcomes in infants who failed NBHS and underwent early tympanostomy tube placement for OME.
- To identify factors influencing outcomes such as recurrent acute otitis media (AOM) and sensorineural hearing loss (SNHL).
Main Methods:
- A retrospective case series design was employed.
- Data from 171 infants who failed NBHS and received tympanostomy tubes before six months of age were analyzed.
- Audiograms, medical records, and risk factors were reviewed.
Main Results:
- Sensorineural hearing loss (SNHL) was identified in 12.9% of infants post-effusion resolution.
- Recurrent acute otitis media (AOM) and the need for repeat tympanostomy tube placements were common.
- Craniofacial anomalies were associated with increased tube replacement and AOM, but less SNHL.
Conclusions:
- OME is a significant reason for failed NBHS, necessitating tympanostomy tubes in some infants.
- A substantial number of infants subsequently develop SNHL, underscoring the need for post-operative hearing evaluations.
- Infants receiving early tubes for OME often face recurrent ear infections and multiple tube insertions.
Objective:
To review the otologic outcomes of infants who failed the newborn hearing screen (NBHS) and received early tympanostomy tubes for otitis media with effusion (OME).
Study Design:
Retrospective case series.
Setting:
Tertiary care pediatric hospital.
Subjects And Methods:
Consecutive patients (2007-2018) who failed an NBHS and required tympanostomy tubes before 6 months of age were included. Variables including hearing loss and otitis media risk factors, episodes of acute otitis media (AOM), number of subsequent tympanostomy tubes, and posttympanostomy tube audiogram results were recorded.
Results:
The cohort included 171 patients. Median age at referral to otolaryngology was 2.7 months. Sensorineural hearing loss (SNHL) was subsequently identified in 22 (12.9%) of infants after resolution of the effusion. The peak incidence of AOM was during the second year of life (1-1.9 years), with a median of 1 episode. Ninety-five patients (55.6%) had replacement of tubes, 41 of 171 (24.0%) had 2 or more additional sets of tubes, and long-term tubes were eventually placed in 8 of 95 (8.4%) patients. Craniofacial anomalies were identified in 43.3% of patients. Tube replacement (hazard ratio, 3.00; 95% CI, 1.95-4.63; P < .01, log-rank) and AOM (β, 1.04; 95% CI, 0.43-1.65; P = .04, ordered logistic regression) were more common, and SNHL less common (odds ratio, 0.17; 95% CI, 0.031-0.61; P < .01, logistic regression), in children with craniofacial anomalies.
Conclusion:
OME is a common cause of failed NBHS. A notable proportion was subsequently found to have SNHL, reiterating the need for postoperative hearing assessments. Infants meeting indication for early tympanostomy tubes for resolution of OME have a high incidence of recurrent AOM and require subsequent tubes.
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