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[Discussion on timing and method of surgical treatment for infants with middle ear effusion]
Yanling Hu1, Zhongfang Xia1, Cong Yao2
1Department of Otolaryngology，Wuhan Children's Hospital，Tongji Medical College，Huazhong University of Science and Technology，Wuhan，430016，China.
Insights
Middle ear effusion in infants can often resolve naturally within six months. Surgical intervention for persistent cases should consider the disease course and influencing factors, with tympanotomy tubes being a common method.
Area of Science:
- Pediatrics
- Otolaryngology
- Audiology
Background:
- Middle ear effusion (MEE) is common in infants following hearing screening failures.
- Determining optimal timing for surgical intervention in neonates with MEE is crucial.
Purpose of the Study:
- To investigate the appropriate timing and surgical methods for neonates with MEE.
- To analyze the self-healing time and influencing factors of MEE in infants.
Main Methods:
- 103 infants with MEE were followed monthly.
- Cases were categorized into improvement, relapse, and persistent groups after 3 months.
- Surgical intervention (tympanostomy with ventilation tubes) was considered after 6 months for persistent or worsening cases.
Main Results:
- Median self-healing time was 7 months; natural recovery decreased significantly after 9 months.
- Self-healing rates varied, with the lowest observed in cases with maxillofacial deformities (8.33%).
- 22 infants underwent surgery, with 94.45% of persistent cases requiring intervention; hearing normalized post-surgery, but recurrence occurred in 4 cases (18.2%).
Conclusions:
- Observation for over 6 months is recommended before considering surgery for infant MEE.
- Disease course and influencing factors are key to timing surgical intervention.
- Tympanotomy tubes are suggested for surgical intervention, acknowledging a high recurrence risk.
Abstract:
Objective:To investigate the timing and method of surgical intervention for neonates diagnosed with middle ear effusion after hearing screening failure. Methods:① A total of 103 children were enrolled in this study and received follow-up evaluations for every month. ② After the first follow-up period for 3 months, the uncured cases were divided into three groups according to the course of the illness. Group Ⅰ is the group of improvement, group Ⅱ is the group of relapse, and the group Ⅲ is the persistent group. The infants will receive symptomatic treatment if necessary. After 6 months, surgical treatment would be recommended in the persistent cases and aggravation, the cases of improvement and cases that the parents don't receive the operation would continue to be observed. All patients were observed till they were cured or operated. The operation was performed with tympanostomy and ventilation tube insertion if necessary. ③The distribution of self-healing time was analyzed. Compare the difference of the number of the cases who followed up for 3 months, 6 months and finally recovered naturally. The self-healing rates of different influencing factors were compared. The final operation rate of group Ⅰ, groupⅡ and group Ⅲ were compared. Results:① The median distribution of self-healing time（month age） in 103 cases was 7.00[5.76, 8.24], and the number of self-healing cases decreased significantly after 9 months of age. There were 43 cases（41.75%）, 67 cases（65.5%） and 81 cases（78.64%） recovered naturally after 3 months, 6 months and follow-up in the end, and the difference was statistically significant. ②The self-healing rate of maxillofacial deformities was the lowest（8.33%）, and the difference was statistically significant compared with other factors. ③The final 22 cases underwent surgical treatment, including 1 case in group Ⅰ（3.45%）, 4 cases in group Ⅱ（30.77%）, and 17 cases in group Ⅲ（94.45%）, with statistically significant difference. ④17 children underwent tympanoplasty, 1 patient underwent tympanoplasty and adenoidectomy, and 4 children only underwent tympanotomy. The hearing of 22 cases returned to normal after operation, but 4 cases of patients with tympanotomy had recurrent tympanic effusion, among which 2 cases had serious effusion and had to be operated again. Conclusion:The infants diagnosed with tympanic effusion can be observed for more than 6 months before surgical intervention is considered. The characteristics of disease course and influencing factors during the follow-up period are of great significance to determine the time of surgical intervention for tympanic effusion in infants. Due to the long observation period, the operative method is suggested to perform tympanotomy tubes, and the possibility of recurrence after tympanotomy is high.
