Several factors have led to the current epidemic of surgery for glue ear in children, including the widespread introduction of audiometry; greater recognition of the presence of fluid in the middle ear by general practitioners; the availability of more otolaryngologists; and technical advances such as the availability of antibiotics to treat postoperative infections and of flanged tympanostomy tubes (grommets). The need of surgeons to fill the vacuum caused by the decline in the number of adenotonsillectomies, and the fact that a diagnosis of glue ear legitimises the continued use of these operations, may also have contributed to the increase. Finally, glue ear may provide parents with a medical explanation of their children's poor educational performance, as the term dyslexia did in the past. The high social and public costs of this operation demand a reappraisal of its increasing use. (+info)
Tympanostomy tube complications and efficacy in children of a rural community.
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In the pediatric group practice and the otolaryngologic practice of our rural community, 41 patients were seen in 1984 with 49 episodes of suppurative discharge after tympanostomy tube insertion. Streptococcus pneumoniae was the most common organism after upper respiratory tract infection. Staphylococcus or enteric organisms were most frequently encountered after bathing or swimming. Most patients regained hearing within normal limits. The benefits of tympanostomy tubes in terms of good hearing and reduced incidence of suppurative otitis media outweigh the risk of transitory suppuration for most patients. (+info)
Middle ear effusion in children: a report of treatment in 500 cases.
(67/83)
Records were studied of 500 children younger than 9 years of age with middle ear effusion who had received one of three treatment strategies: (1) administration of medication, including decongestants, antihistamines or antibiotics (or a combination), (2) administration of medication for a limited time and then surgical therapy if effusion did not resolve or (3) myringotomy done immediately with insertion of ventilation tubes and, in some cases, removal of adenoids. Early surgical intervention resulted in significantly shorter delay in hearing restoration. It did not result in a lower recurrence rate and it did not reduce the number of occasions when thick fluid, as compared with thin fluid, was found at operation. Four children for whom medical and surgical treatment failed were considered candidates for mild gain, low maximum-power-output hearing aids. All other children had normal hearing after treatment. Medication was successful in achieving this goal in 48 percent of the cases. (+info)
Factors affecting the extrusion rates of ventilation tubes.
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A survey in which 939 ventilation tubes of 8 different patterns were inserted and reviewed (up to a maximum of 2 1/4 years) is analysed. Various factors determining the rate of extrusion are discussed. The Sheehy Collar Button tube remained functional for a longer period than any of the other tubes included in the survey. (+info)
Tympanic epithelium: an ultrastructural, experimental and clinical study.
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Ultrastructural studies of the guinea pig tympanic membrane failed to reveal specific morphological features that could be associated with migration. A staining method was used to study epithelial migration on 68 normal guinea pig tympanic membranes. A very predictable migratory pattern emerged which was neither influenced by perforation or ventilating tube insertion. Clinical studies in children on 61 normal tympanic membranes revealed a rapid migration which was unchanged by middle ear effusion. A centrifugal pattern of migration was observed in relation to the 23 chronic perforations studied. The kinetics of epithelium in relation to 41 ventilating tubes and in 23 retraction pockets is described. (+info)
Swimming and grommets.
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The dictum that patients who have plastic ventilation tubes (grommets) inserted in their tympanic membranes should not go swimming is questioned. A theoretical assessment is made of the pressure necessary to push water through a grommet. This value is compared with practical observations. These values are discussed with reference to chemical and bacteriological hazards and it is concluded that water is unlikely to enter the middle ear in surface swimming, and even when diving underwater the chances of setting up an otitis media must be small. (+info)
Surgery for glue ear: the English epidemic wanes.
(71/83)
OBJECTIVES: To describe the progress of the epidemic of surgery for glue ear since 1983 and trends in the use of different operative procedures. DESIGN: Analysis of routine hospital data. SETTING: Thirteen health districts in the Oxford and East Anglian regions. MAIN MEASURES: Annual rates of surgery in children under 10 years of age. RESULTS: The rate of surgery for glue ear reached a peak in 1986 since when it has declined by 12.6%. The rate peaked in all 13 districts but at different times over a six year period (1984-1989/90). Following the peak, district rates plateaued in eight districts and declined in five. These changes have been accompanied by: an increase in the proportion of operations confined to the tympanic membrane since 1983 (from 40% to 60%); an increase in the use of grommets after myringotomy (from 50% to 94% since 1980); and an increased use of day surgery for ear-only operations (from about 10% in the late 1970s to 50% in 1987/88). CONCLUSIONS: The previously reported epidemic of surgery for glue ear is waning. This seems to be a result of changes in the clinical judgment of general practitioners and surgeons as to its use and possibly of a reduced demand from parents. (+info)
Late diagnosis of congenital sensorineural hearing impairment: why are detection methods failing?
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This study was designed to look in detail at the paths to diagnosis for a group of 197 children with congenital sensorineural hearing impairment (SNHI), who were diagnosed between 1989 and 1991 in the state of Victoria, Australia. Despite the existence of universal infant screening at 7-9 months by distraction test or questionnaire, the median age at diagnosis for the study group was 18.0 months, with median age at aid fitting of 20.8 months, and median age at commencement of specialised intervention programmes of 22.3 months. Parent questionnaires completed for 143 (73%) of these children showed that 49% had known risk factors for hearing loss yet only 20% of them had been referred for audiological assessment before the 7-9 month screen. Only 63% of those eligible for the 7-9 month screen had received it. Of those children who were screened by distraction test 46% passed as did 57% of those screened by questionnaire. Twenty four parents (17%) described how they had initially 'denied' their own observations of their infants' abnormal hearing behaviour. When concerns were raised with professionals, 10% of parents were falsely reassured without audiological assessment. Detection methods are failing through a combination of poor screen test efficacy, incomplete population coverage, and parental and professional denial. (+info)