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Published on: January 17, 2011
Mechanical ventilation and middle ear effusions among tracheostomy-dependent children
Erin M Wynings1, Hussein Jaffal2, Rachel St John3
1Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Insights
Children with tracheostomies needing mechanical ventilation have a significantly higher risk of developing middle ear effusion (MEE). Early assessment for MEE is crucial for this vulnerable pediatric population.
Area of Science:
- Pediatric Otolaryngology
- Respiratory Medicine
- Developmental Pediatrics
Background:
- Middle ear effusion (MEE) is common in children.
- Tracheostomy and mechanical ventilation are associated with increased respiratory and potentially otologic complications.
- Understanding MEE incidence in this specific population is critical for early intervention.
Purpose of the Study:
- To determine the cumulative 24-month incidence of middle ear effusion (MEE) in children dependent on tracheostomy and ventilatory support.
- To identify risk factors associated with MEE development in this cohort.
Main Methods:
- Prospective longitudinal cohort study of children under 2 years with tracheostomy.
- Inclusion criteria: tertiary care hospital, 2015-2020, at least one tympanometry exam.
- MEE defined by tympanometry; mechanical ventilation status recorded.
Main Results:
- 56.5% of children developed MEE within 24 months post-tracheostomy.
- Children on mechanical ventilation had a 2.97-fold increased risk of MEE (74.0% vs. 31.2%).
- Ventilator dependence significantly predicted MEE presence (OR: 2.34) after controlling for confounders.
Conclusions:
- Mechanical ventilation is a significant predictor of MEE in tracheostomy-dependent children.
- Clinicians must assess for MEE in this population to prevent adverse speech and language outcomes.
- Early identification and management of MEE can improve developmental trajectories.
Objective:
To determine the cumulative 24-month incidence of middle ear effusion (MEE) among tracheostomy-dependent children requiring ventilatory support.
Methods:
A prospective longitudinal cohort study included all children under 2 years of age with a tracheostomy placed at a tertiary care children's hospital between 2015 and 2020 that obtained at least one tympanometry exam. The development of MEE, defined as a flat tympanogram with normal external canal volume, and mechanical ventilation requirement at examination were recorded.
Results:
Ninety-four children with a mean age at tracheostomy of 5.4 months (SD: 3.7) were included. During a mean follow-up of 18.3 months (SD: 14.6) (median: 14.1 months, interquartile range: 6.6-27.8), 192 tympanometry examinations were obtained with 59% (114/192) while requiring mechanical ventilation. Within 24 months after tracheostomy, 56.5% (95% CI: 48.9-64.4%) of children developed at least one MEE. Among those on mechanical ventilation, 74.0% (95% CI: 65.6-82.5%) developed MEE compared to 31.2% (95% CI: 21.4-44.0%) not on mechanical ventilation (HR: 2.97, 95% CI: 1.46-6.05, P = .003). A persistent MEE on two consecutive exams was not statistically more common for children on a ventilator (OR: 0.64, 95% CI: 0.01-6.95, P = .70). When controlling for age at exam, craniofacial syndrome, and newborn hearing test results on logistic regression, ventilator-dependence significantly predicted the presence of MEE (OR: 2.34, 95% CI: 1.18-4.68, P = .02).
Conclusion:
Children with a tracheostomy were more likely to develop MEE when requiring mechanical ventilation. Clinicians should recognize this risk factor and appropriately assess for development of MEE to mitigate adverse speech and language development outcomes in this vulnerable population.
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