Document Detail


Chronic secretory otitis media: effects of surgical management.
MedLine Citation:
PMID:  2492178     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
To study the effectiveness of adenoidectomy and tympanostomy tubes in the treatment of chronic otitis media with effusion, we randomly assigned 578 4- to 8-year-old children to receive one of the following: bilateral myringotomy and no additional treatment (group 1), tympanostomy tubes (group 2), adenoidectomy and myringotomy (group 3), or adenoidectomy and tympanostomy tubes (group 4). The 491 who accepted surgical treatment were evaluated at 6-week intervals for up to 2 years. Treatment effect was assessed by four main outcomes: time with effusion, time with hearing loss, time to first recurrence of effusion, and number of surgical re-treatments. For the groups (in order), the mean percent of time with any effusion in either ear was 49, 35, 30, 26 (p less than .0001); the mean percent of time with hearing thresholds 20 dB or greater was 19, 10, 8, and 7 (p less than .0001) in the better ear; and 38, 30, 22 and 22 in the worse ear (p less than .0001); the median number of days to first recurrence was 54, 222, 92, and 240 (p less than .0001); and the number of surgical re-treatments was 66, 36, 17, and 17 (p less than .0001). The most notable adverse sequela, purulent otorrhea, occurred in 22%, 29%, 11%, and 24% of the patients assigned to groups 1 through 4, respectively (p less than .001). In severely affected children who have chronic otitis media with effusion resistant to medical therapy, adenoidectomy is an effective treatment. Adenoidectomy plus bilateral myringotomy lowered posttreatment morbidity more than tympanostomy tubes alone and to the same degree as did adenoidectomy and tympanostomy tubes. Adenoidectomy appears to modify the underlying pathophysiology of chronic otitis media with effusion. This effect is independent of the preoperative size of the adenoid. Tympanostomy tube drainage and ventilation of the middle ear provide adequate palliation so long as the tubes remain in place and functioning. We recommend that adenoidectomy be considered in the initial surgical management of 4- to 8-year-old children with hearing loss due to chronic secretory otitis media that is refractory to medical management and, further, that the size of the adenoid not be used as a criterion for adenoidectomy. Concomitant bilateral myringotomy with suction aspiration of the middle ear contents also should be done, with or without placement of tympanostomy tubes at the discretion of the surgeon.
Authors:
G A Gates; C A Avery; J C Cooper; T J Prihoda
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The Annals of otology, rhinology & laryngology. Supplement     Volume:  138     ISSN:  0096-8056     ISO Abbreviation:  Ann Otol Rhinol Laryngol Suppl     Publication Date:  1989 Jan 
Date Detail:
Created Date:  1989-02-14     Completed Date:  1989-02-14     Revised Date:  2008-02-21    
Medline Journal Info:
Nlm Unique ID:  1256156     Medline TA:  Ann Otol Rhinol Laryngol Suppl     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  2-32     Citation Subset:  IM    
Affiliation:
Division of Otorhinolaryngology, University of Texas Health Science Center, San Antonio.
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MeSH Terms
Descriptor/Qualifier:
Acoustic Impedance Tests
Adenoidectomy*
Child
Child, Preschool
Chronic Disease
Endoscopy
Female
Follow-Up Studies
Hearing Disorders / physiopathology
Humans
Male
Middle Ear Ventilation*
Otitis Media with Effusion / physiopathology,  surgery*
Prognosis
Prospective Studies
Recurrence
Reoperation
Tympanic Membrane / surgery
Grant Support
ID/Acronym/Agency:
N01 NS 02328/NS/NINDS NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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