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      Seqüelas de tubos de ventilação em crianças com otite média com efusão: um seguimento de três anos Translated title: Tympanostomy tube sequelae in children with otitis media with effusion: a three-year follow-up study

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          Abstract

          A inserção de tubos de ventilação (TV) é um dos procedimentos mais comuns em otorrinolaringologia. Otorréia, timpanoesclerose, retração, perfuração e colesteatoma após a colocação de tubos de ventilação são complicações citadas na literatura. OBJETIVOS: Determinar o tipo e a incidência de seqüelas/complicações de TV em crianças com otite média recorrente e otite média com efusão crônica que foram submetidas a miringotomia com colocação de TV. FORMA DE ESTUDO: Estudo de coorte, longitudinal prospectivo. MATERIAL E MÉTODO: Setenta e cinco crianças (150 orelhas) entre 11 meses e 10 anos de idade foram monitoradas regularmente durante até 38 meses após a colocação de TV. RESULTADOS: Incidência de seqüelas/complicações: otorréia - 47,3% das orelhas; perfuração - 2,1%; retração do tímpano - 39,7%; timpanoesclerose - 23,3%. Tempo médio de permanência do TV: 12,13 meses. Idade média na primeira cirurgia de quem não foi re-operado = 35,9 meses e idade média na primeira cirurgia de quem sofreu re-inserção = 25,6 meses (P=0,04). O TV permaneceu mais tempo nas orelhas com mais episódios de otorréia (P=0,01). A colocação de TV com adenoidectomia associou-se a uma freqüência menor de otorréias (P=0,02). CONCLUSÕES: Otorréia foi a complicação de colocação de TV mais incidente. A colocação de TV com adenoidectomia associou-se a um menor número de otorréias. O TV permaneceu mais tempo nas orelhas com maior freqüência de otorréias. Pouca idade na ocasião da primeira colocação de TV está associada a uma incidência maior de re-inserção de TV. Um em cada seis pacientes provavelmente necessitará uma segunda inserção de TV.

          Translated abstract

          Tympanostomy tube (TT) insertion is one of the most frequently performed procedures in otolaryngology. Otorrhea, tympanosclerosis, retraction, perforation, and cholesteatoma are complications reported in the literature after its application. AIM: To determine the incidence and the type of TT insertion sequelae/complications in children presenting with recurrent otitis media and chronic otitis media with effusion undergoing myringotomy and tube placement. STUDY DESIGN: prospective cohort study. MATERIAL AND METHOD: A total of 75 children (150 ears) aged 11 months to 10 years were regularly followed up for up to 38 months after TT insertion. RESULTS: Incidence of sequelae/complications: otorrhea - 47.3% of the ears; perforation - 2.1%; retractions - 39.7%; tympanosclerosis - 23.3%. Average length of stay: 12.13 months. Mean age at initial tube placement of children not requiring a second set of tubes = 35.9 months and mean age at initial tube insertion of children requiring an additional set of tubes = 25.6 months (P=0.04). TT stayed longer in the ears that had more episodes of otorrhea (P=0.01). TT insertion with adenoidectomy was associated with a smaller number of otorrhea episodes (P=0.02) CONCLUSIONS: Otorrhea was the most frequently found complication. TT placement with adenoidectomy was associated with fewer otorrhea episodes. TT extruded later in those ears that had more episodes of otorrhea. Younger age at the time of the initial tube placement is associated with higher incidence of additional tube placement. One in six patients will probably require a second set of ventilation tubes.

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          Clinical practice guideline: Otitis media with effusion.

          R Rosenfeld, , Martin C Mahoney … (2004)
          The clinical practice guideline on otitis media with effusion (OME) provides evidence-based recommendations on diagnosing and managing OME in children. This is an update of the 1994 clinical practice guideline "Otitis Media With Effusion in Young Children," which was developed by the Agency for Healthcare Policy and Research (now the Agency for Healthcare Research and Quality). In contrast to the earlier guideline, which was limited to children aged 1 to 3 years with no craniofacial or neurologic abnormalities or sensory deficits, the updated guideline applies to children aged 2 months through 12 years with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The American Academy of Pediatrics, American Academy of Family Physicians, and American Academy of Otolaryngology-Head and Neck Surgery selected a subcommittee composed of experts in the fields of primary care, otolaryngology, infectious diseases, epidemiology, hearing, speech and language, and advanced practice nursing to revise the OME guideline. The subcommittee made a strong recommendation that clinicians use pneumatic otoscopy as the primary diagnostic method and distinguish OME from acute otitis media (AOM). The subcommittee made recommendations that clinicians should (1) document the laterality, duration of effusion, and presence and severity of associated symptoms at each assessment of the child with OME; (2) distinguish the child with OME who is at risk for speech, language, or learning problems from other children with OME and more promptly evaluate hearing, speech, language, and need for intervention in children at risk; and (3) manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known), or from the date of diagnosis (if onset is unknown). The subcommittee also made recommendations that (4) hearing testing be conducted when OME persists for 3 months or longer, or at any time that language delay, learning problems, or a significant hearing loss is suspected in a child with OME; (5) children with persistent OME who are not at risk should be reexamined at 3- to 6-month intervals until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected; and (6) when a child becomes a surgical candidate, tympanostomy tube insertion is the preferred initial procedure. Adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); repeat surgery consists of adenoidectomy plus myringotomy, with or without tube insertion. Tonsillectomy alone or myringotomy alone should not be used to treat OME. The subcommittee made negative recommendations that (1) population-based screening programs for OME not be performed in healthy, asymptomatic children and (2) antihistamines and decongestants are ineffective for OME and should not be used for treatment; antimicrobials and corticosteroids do not have long-term efficacy and should not be used for routine management. The subcommittee gave as options that (1) tympanometry can be used to confirm the diagnosis of OME and (2) when children with OME are referred by the primary clinician for evaluation by an otolaryngologist, audiologist, or speech-language pathologist, the referring clinician should document the effusion duration and specific reason for referral (evaluation, surgery), and provide additional relevant information such as history of AOM and developmental status of the child. The subcommittee made no recommendations for (1) complementary and alternative medicine as a treatment for OME based on a lack of scientific evidence documenting efficacy and (2) allergy management as a treatment for OME based on insufficient evidence of therapeutic efficacy or a causal relationship between allergy and OME. Last, the panel compiled a list of research needs based on limitations of the evidence reviewed. The purpose of this guideline is to inform clinicians of evidence-based methods to identify methods to identify, monitor, and manage OME in children aged 2 months through 12 years. The guideline may not apply to children older than 12 years because OME is uncommon and the natural history is likely to differ from younger children who experience rapid developmental change. The target population includes children with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The guideline is intended for use by providers of health care to children, including primary care and specialist physicians, nurses and nurse practitioners, physician assistants, audiologists, speech-language pathologists, and child development specialists. The guideline is applicable to any setting in which children with OME would be identified, monitored, or managed. This guideline is not intended as a sole source of guidance in evaluating children with OME. Rather, it is designed to assist primary care and other clinicians by providing an evidence-based framework for decision-making strategies. It is not intended to replace clinical judgment or establish a protocol for all children with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.
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            Meta-analysis of tympanostomy tube sequelae.

            Ken M. Nelson, Christina D. Kay, R Rosenfeld (2001)
            To estimate the incidence of tympanostomy tube sequelae based on systematic review of published case series and randomized studies. English-language MEDLINE search from 1966 through April 1999 with manual reference search of proceedings, articles, reports, and guidelines. Cohort studies with otitis media as the primary indication for tube placement. Two reviewers independently extracted data from 134 articles. Transient otorrhea occurred in 16% of patients in the postoperative period and later in 26%; recurrent otorrhea occurred in 7.4% of patients and chronic otorrhea in 3.8%. Sequelae of indwelling tubes included obstruction (7% of ears), granulation tissue (5%), premature extrusion (3.9%), and medial displacement (0.5%). Sequelae after tube extrusion included tympanosclerosis (32%), focal atrophy (25%), retraction pocket (3.1%), cholesteatoma (0.7%), and perforation (2.2% with short-term tubes, 16.6% with long-term tubes). Meta-analysis showed that long-term tubes increased the relative risk of perforation by 3.5 (95% CI, 1.5 to 7.1) and cholesteatoma by 2.6 (95% CI, 1.5 to 4.4). Similarly, intubation increased the relative risk of tympanosclerosis by 3.5 (95% CI, 2.6 to 4.9) and focal atrophy by 1.7 (95% CI, 1.1 to 2.7) over nonintubated control ears (baseline tympanosclerosis and atrophy rates of 10% and 14%, respectively). Sequelae of tympanostomy tubes are common but are generally transient (otorrhea) or cosmetic (tympanosclerosis, focal atrophy). Nonetheless, the high incidence suggests a need for ongoing otologic surveillance of all patients with indwelling tubes and for a reasonable time period after tube extrusion. Long-term tubes should be used on a selective and individualized basis.
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              Otorrhea in young children after tympanostomy-tube placement for persistent middle-ear effusion: prevalence, incidence, and duration.

              C Ah-Tye, J Paradise, D Colborn (2001)
              To characterize the occurrence of tube otorrhea after tympanostomy-tube placement (TTP) for persistent middle-ear effusion (MEE) in a group of otherwise healthy infants and young children.
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                Author and article information

                Journal
                Journal ID (publisher-id): rboto
                Title: Revista Brasileira de Otorrinolaringologia
                Abbreviated Title: Rev. Bras. Otorrinolaringol.
                Publisher: ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (São Paulo, SP, Brazil )
                ISSN (Print): 0034-7299
                Publication date (Print and electronic): August 2005
                Volume: 71
                Issue: 4
                Pages: 415-420
                Affiliations
                [01] orgnameSistema de Saúde Mãe de Deus orgdiv1Ambulatório de Otorrinolaringologia Pediátrica
                [02] orgnameUniversidade de Manitoba
                [05] orgnameSistema de Saúde Mãe de Deus orgdiv1Ambulatório de Otologia
                [04] orgnameUniversidade Federal do Rio Grande do Sul orgdiv1Faculdade de Medicina orgdiv2Departamento de Otorrinolaringologia e Oftalmologia
                [03] orgnamePontifícia Universidade Católica do Rio Grande do Sul orgdiv1Faculdade de Medicina
                Article
                Publisher ID: S0034-72992005000400003 Publisher ID: S0034-7299(05)07100403
                SO-VID: 6c71f7af-69e5-482e-ab8a-02e650747ec7
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                Date received : 08 March 2005
                Date accepted : 31 May 2005
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 25, Pages: 6
                Product

                SciELO Brazil

                Categories
                Subject: Artigos Originais

                Keywords: otite média,child,middle ear ventilation,middle,ear,otitis media with effusion,otitis media,criança,ventilação da orelha média,orelha média,otite média com derrame,otite média secretora
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                Keywords: otite média, child, middle ear ventilation, middle, ear, otitis media with effusion, otitis media, criança, ventilação da orelha média, orelha média, otite média com derrame, otite média secretora

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