Grommets versus paracentesis in secretory otitis media. A prospective, controlled study

Area of Science:

• Otolaryngology
• Pediatric Medicine
• Audiology

Background:

• Secretory otitis media (SOM) is common in children, potentially leading to hearing loss.
• Effective management strategies for SOM are crucial to prevent long-term complications.

Purpose of the Study:

• To evaluate the efficacy and adverse effects of grommet insertion versus paracentesis alone in treating bilateral SOM in children.
• To identify factors predicting persistent or recurrent SOM requiring further intervention.

Main Methods:

• A cohort of 193 children with bilateral SOM underwent adenoidectomy, paracentesis, and unilateral grommet insertion (right ear only).
• Audiometric and tympanometric assessments were performed at 1-3 year follow-up.
• Pre- and perioperative factors were analyzed for correlation with treatment outcomes.

Main Results:

• Grommet insertion normalized hearing in the treated ear while functioning, with only 1% exceeding 30 dB HL compared to 20% without grommets.
• Adverse effects included aural discharge (14%) and tympanosclerosis (48% with grommets vs. 10% with paracentesis alone).
• Reinsertion was needed in 10% of right ears and 23% of left ears; granulating mucosa and effusion predicted recurrence.

Conclusions:

• Unilateral grommet insertion effectively restores hearing in children with SOM but carries risks of discharge and tympanosclerosis.
• Persistent middle ear effusion and specific intraoperative findings indicate a higher likelihood of requiring repeated treatment.
• Careful consideration of risks and benefits is necessary when deciding on grommet insertion for SOM.