Long‐Term Otitis Media Outcomes in Infants With Early Tympanostomy Tubes

Abstract

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.

Outcomes and Management of Infants Who Refer Newborn Hearing Screening

“…Of the 35 children with OME, 4 (11.4%) also had SNHL. This is similar to the findings of Luu et al 18 who reported that 22/171 (12.9%) infants with tubes placed for OME that was diagnosed when these infants failed newborn hearing screening also had SNHL on repeat testing after the tubes were placed. The timing of tympanostomy tube placement in patients varied depending on the patient age of presentation, duration of effusion, recurrence of effusion, and ability to rule out SNHL.…”

“…Similarly, the reported incidence of OME as a cause of failed screening varies widely with values ranging from 2.9% to 55.3%. 5,[16][17][18] Birth by caesarean delivery is a potential cause of retained middle ear fluid leading to failed initial OAE. 19 Unfortunately, this information was not present on chart review for many patients in this study.…”

Efficacy and Safety of Endoscopic Tympanic Membrane Catheterization Plus Ofloxacin Ear Drops in the Treatment of Secretory Otitis Media in Infants and Toddlers

“…e new type of quinolone broad-spectrum antibacterial drugs can reduce the drug tolerance of bacteria, greatly improve the bactericidal activity of drugs, and effectively curb the generation of drug resistance. It acts on bacterial type II-A topoisomerases (DNA rotase and topoisomerase IV) [2][3][4]. Studies have shown that the process of bacterial DNA replication is essential for the growth and survival of bacteria, and this process requires the combined action of DNA rotase and topoisomerase IV [4].…”

“…Secretory otitis media is mainly characterized by ear aches, tinnitus, ear discomfort, hearing loss, and middle ear effusion [ 2 ]. Due to the underdevelopment of muscles and cartilage of the eustachian tube in infants and toddlers, the muscles of the body are prone to weak contractions, leading to the pressure resulting from the collapse of the cartilage tube and inducing secretory otitis media [ 3 ]. Li et al [ 4 ] highlighted that secretory otitis media in infants and toddlers entails adverse effects on their language competence, intelligence, and development.…”

Effectiveness of Surgical Approach of Insertion Ventilation Tubes (Tympanostomy) and Adenoidectomy in Comparison with Non-Surgical Approach (Watchful Waiting Approach) in Children at the Age between 1 and 6 and Who Suffer from Otitis Media with Effusion (OME) in 12-Month Period of Observation—The Retrospective Analysis

“…Only in cases where the problem persists may surgery be required [ 6 ]. A range of research findings show how important it is to identify children with hearing disorders and implement appropriate treatment and rehabilitation early on [ 7 , 8 , 9 ]. Childhood hearing screening in school children should be the primary tool for identifying hearing loss that was not recognized at birth or that developed later [ 10 , 11 , 12 ].…”