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Follow up after middle-ear ventilation tube insertion: what is needed and when?

Published online by Cambridge University Press:  30 November 2007

P M Spielmann ,
H McKee ,
R M Adamson ,
G Thiel ,
D Schenk  and
S S M Hussain
P M Spielmann*
Affiliation:
Department of Otolaryngology, Raigmore Hospital, Inverness, Aberdeen, Scotland, UK
H McKee
Affiliation:
Department of Otolaryngology, Ninewells Hospital and Medical School, Dundee, Aberdeen, Scotland, UK
R M Adamson
Affiliation:
Department of Otolaryngology, Victoria Hospital, Kirkcaldy, Scotland, UK
G Thiel
Affiliation:
Department of Otolaryngology, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
D Schenk
Affiliation:
Department of Otolaryngology, Ninewells Hospital and Medical School, Dundee, Aberdeen, Scotland, UK
S S M Hussain
Affiliation:
Department of Otolaryngology, Ninewells Hospital and Medical School, Dundee, Aberdeen, Scotland, UK
*
Address for correspondence: Mr P M Spielmann, Department of Otolaryngology, Raigmore Hospital, Inverness IV2 3UJ, Scotland, UK. Fax: 01463706028 E-mail: patrickspielmann@nhs.net
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Abstract

Introduction:

There is a paucity of evidence to guide the post-operative follow up of patients undergoing middle-ear ventilation tube insertion for the first time. This study was conceived to identify current practice at our institution (Ninewells Hospital, Dundee) and to inform subsequent change in our follow-up procedure.

Methods:

Two cycles of data collection and analysis were performed. All paediatric patients undergoing ventilation tube insertion for the first time were identified. Patients who had previously undergone ventilation tube insertion or additional procedures such as adenoidectomy or tonsillectomy were excluded. The first data collection period comprised all of the year 2000, and the second 18 months over 2003–2004. A minimum of 20 months' follow up was allowed for. Data regarding clinical findings and audiometry were recorded at each follow-up appointment.

Results:

We identified a total of 50 patients meeting our criteria for inclusion in the first cohort. There were a total of 156 appointments between surgery and data collection (a mean of 3.12 per child). A total of 113 (72 per cent) appointments lead to no medical intervention. The only statistically significant difference between patients requiring further ventilation tube insertion (n = 10) and those not requiring further treatment during the study period (n = 40) was the average hearing threshold (p < 0.01). These findings prompted a change in the post-operative regime; all patients undergoing ventilation tube insertion were subsequently seen at three months for a pure tone audiogram, and further review depended on clinical and audiometric findings. Records for 84 children were identified and collected for the second cohort, there were a total of 154 appointments (a mean of 1.83 per child). In only 18 appointments (12 per cent) were normal findings and hearing recorded and children given a further review appointment. Sixteen of 29 (55 per cent) children with abnormal clinical findings (otorrhoea, tube blockage or extrusion) required some form of intervention (p < 0.05). Twenty-six had a mean hearing threshold worse than 20 dB at first review. Nineteen (73 per cent) required further intervention of some sort (p < 0.01).

Conclusions:

Our study demonstrated that the vast majority of review appointments resulted in no clinical intervention. We therefore question the need for regular follow up in this patient group. Twenty per cent (10 of 50 and 18 of 84) of our patients required further ventilation tube insertion within the study periods. This is consistent with rates reported in the literature. Children with abnormal clinical findings or a mean hearing threshold greater than 20 dB were significantly more likely to require further intervention. We would recommend one post-operative review with audiometry, three months after surgery. At this initial appointment, further review should be offered to those children with poor hearing, early extrusion, blockage or infection, as they are more likely to require further ventilation tube insertion. This strategy is dependent on good links with community primary care providers and easy access to secondary care for further management, should this be required.

Keywords

Ventilation TubeGrommetFollow up
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 6 , June 2008 , pp. 580 - 583
Copyright
Copyright © JLO (1984) Limited 2007

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References

1 Isaacson, G, Rosenfeld, RM. Care of the child with tympanostomy tubes. Pediatr Clin North Am 1996;43:1183–93Google Scholar
2 Mason, J, Freemantle, N, Browning, G. Impact of effective health care bulletin on treatment of persistent glue ear in children: time series analysis. BMJ 2001;323:1096–7CrossRefGoogle ScholarPubMed
3 Rovers, MM, Black, N, Browning, GG, Maw, R, Zielhuis, GA, Haggard, MP. Grommets in otitis media with effusion: an individual patient data meta-analysis. Arch Dis Child 2005;90:480–5CrossRefGoogle ScholarPubMed
4 Derkay, CS, Carron, JD, Wiatrak, BJ, Choi, SS, Jones, JE. Postsurgical follow-up of children with tympanostomy tubes: results of the American Academy of Otolaryngology-Head and Neck Surgery Paediatric Otolaryngology Committee National Survey. Otolaryngol Head Neck Surg 2000;122:313–18CrossRefGoogle ScholarPubMed
5 Section on Otolaryngology & Bronchoesophagology, The American Academy of Pediatrics. Follow-up management of children with tympanostomy tubes. Pediatrics 2002;109:328–9Google Scholar
6 Milford, CA, Vinayak, BC. General practitioner follow-up of children undergoing grommet insertion. Can it work? Clin Otolaryngol 1995;20:1–2CrossRefGoogle ScholarPubMed
7 Montague, ML, Hussain, SS. A child with recurrent acute otitis media. Clin Otolaryngol 2007;32:190–2Google Scholar
8 Boston, M, McCook, J, Burke, B, Derkay, C. Incidence of and risk factors for additional tympanostomy tube insertion in children. Arch Otolaryngol Head Neck Surg 2003;129:293–6Google Scholar
9 Haggard, M. UK Medical Research Council trial of alternative regimens in glue ear treatment (TARGET). In Proceedings of XVIII IFOS (International Federation of Oto-Rhino-Laryngological Societies) Word Congress – Rome, 2005.Google Scholar
10 Kalcioglu, MT, Cokkeser, Y, Kizilay, A, Ozturan, O. Follow-up of 366 ears after tympanostomy tube insertion: why is it draining? Otolaryngol Head Neck Surg 2003;128:560–4Google ScholarPubMed
11 Goldstein, NA, Roland, JT Jr, Sculerati, N. Complications of tympanostomy tubes in an inner city clinic population. Int J Pediatr Otorhinolaryngol 1996;34:87–99Google Scholar
12 Ah-Tye, C, Paradise, JL, Colborn, DK. Otorrhea in young children after tympanostomy-tube placement for persistent middle ear effusion: prevelance, incidence and duration. Pediatrics 2001;107:1251–8CrossRefGoogle Scholar
13 Wallace, HC, Newbegin, CJR. Does ENT outpatient review at 1 week post ventilation tube insertion improve outcome at 1 month in paediatric patients? Clin Otolaryngol 2004;29:595–7Google Scholar
14 Emery, M, Weber, PC. Hearing loss due to myringotomy and tube placement and the role of preoperative audiograms. Arch Otolaryngol Head Neck Surg 1998;124:421–4CrossRefGoogle ScholarPubMed
15 Manning, SC, Brown, OE, Roland, PS, Phillips, DL. Incidence of sensorineural hearing loss in patients evaluated for tympanostomy tubes. Arch Otolaryngol Head Neck Surg 1994;120:881–4Google Scholar