Outcomes and Complications of Pediatric Eustachian Tube Dilation Surgery.

OBJECTIVE: To determine whether balloon dilation of Eustachian tube (BDET) improves postoperative audiology and quality of life scores in children with chronic Eustachian tube dysfunction. STUDY DESIGN: Retrospective study. SETTING: Tertiary care pediatric center. METHODS: Eligible participants were patients 8 years or older, with a history of 2 prior tubes placement. Group 1-patients completed pre-and post-Eustachian Tube Dysfunction Quality of Life Survey (ETDQ-7) survey scores, Group 2-patients had available pre- and postdilation tympanogram data (TD), and Group 3-patients had both ETDQ-7 survey and TD. The average time for the first and subsequent follow-ups was 3.8 and 12.9 months, respectively. RESULTS: A total of 43 patients (85 ears) underwent BDET. The mean age was 13.3 years (8-18 years). Twenty-four patients were male (55.8%) and over 80% were Caucasian. The average mean ETDQ-7 score before and after dilation was 3.9 and 2.5, respectively. Ninety-three percent experienced improvement of their postoperative ETDQ-7 scores and 53% had normal postdilation ETDQ-7 score (P < .0001). Thirty-seven ears in Group 2 (60.7%) had improvement in postdilation TD. A greater proportion of ears showed improvement of 62.3% with a 95% confidence interval (CI) [50.1%-74.5%] compared to 37.7% without improvement, 95% CI [25.5%-49.87%]. Ears with type A or B TD were more likely to show improvement than ears with type C, perforated, or with tubes (P < .0001). Eighteen out of 30 ears in Group 3 (60%) experienced an improvement in both ETDQ-7 and tympanogram. CONCLUSION: BDET is a safe, efficacious alternative to tubes in selected pediatric patients.

Tympanostomy Tube Insertion Versus Myringotomy or Observation in Managing Otitis Media With Effusion Following Radiotherapy for Nasopharyngeal Carcinoma: An Updated Review.

Head and neck cancers, including nasopharyngeal carcinoma (NPC), are relatively common in Saudi Arabia. Radiotherapy is a standard treatment for NPC, but it can lead to side effects, including post-radiation otitis media with effusion (OME). Managing post-radiotherapy OME remains a topic of debate, with various interventions proposed. This study aims to review the efficacy of different methods to manage post-radiotherapy OME in NPC. This includes tympanostomy tube insertion, frequent myringotomies, and observation. A systematic review was carried out for articles published between 1975 and 2023 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Excluded from the analysis were articles that involved patients undergoing surgical treatment for nasopharyngeal cancer, studies that focused on patients with other head and neck cancers who developed OME after radiotherapy, research investigating the effectiveness of surgical procedures unrelated to tympanostomy tube insertion, studies written in non-English language, and case reports, reviews, or conference letters. A total of 450 studies were screened, of which six studies were included in the review, yielding 328 patients. The mean age ranged between 46 and 52 years. Follow-up varied from six months to 11 years. The intervention in all studies was tympanostomy tube insertion, and the controls were myringotomy, observation, or tympanic membrane fenestration with cauterization. The use of recurrent myringotomies for the treatment of OME in patients with NP post-radiotherapy is associated with improved chances for the resolution of effusion and decreased risk of complications when compared to tympanostomy tube insertion. Hence, we recommend following a step-wise approach when dealing with this group of patients, offering grommets for patients with persistent effusion or those who cannot tolerate frequent procedures.

An Effective Treatment for Recurrent Bilateral Facial Palsy in a Flight Attendant: A Case Report.

Recurrent facial baroparesis is a rare condition that is mostly observed in individuals who have been exposed to barotraumatic conditions, particularly scuba divers and air travelers. We present a case of an unusual bilateral alternating recurrent facial nerve palsy and its successful treatment. A 34-year-old airline stewardess presented with a seven-month history of recurrent bilateral alternating facial nerve palsy that occurred exclusively during airline takeoffs. A clinical diagnosis of facial baroparesis was made. The temporal bone's high-resolution CT (HRCT) scan revealed a bilateral tympanic segment of the facial canal wall dehiscence. Conservative treatment with oral antihistamines and nasal decongestants proved ineffective in treating this unusual condition. The patient then underwent bilateral Eustachian tube dilatation as well as bilateral myringotomy and grommet insertion. Post-treatment, she became asymptomatic despite multiple re-exposure to high-altitude travel. With our successful reported case of this uncommon recurrent condition, Eustachian tube dilatation as well as myringotomy and grommet insertion could potentially become the standard approach to treatment.

Intraoperative and postoperative findings in children with myringotomy tubes (MT) undergoing cochlear implantation (CI).

OBJECTIVE: To evaluate and compare children undergoing cochlear implantation (CI) with myringotomy tubes (MT) placed preoperatively or intraoperatively to those without MT . METHODS: This was a retrospective review of pediatric patients undergoing CI between 2015 to 2020 at a tertiary care pediatric hospital. CI patients with and without MT were reviewed for the following outcomes: intraoperative findings, intraoperative and postoperative complications, and surgical time. Descriptive and bivariable statistical analysis was performed. RESULTS: 192 cochlear implant surgeries were included: 116 without MT tubes and 76 with a history of MT. Twenty-six patients had MT present at the time of CI surgery. No statistical difference existed between patients with MT (CI + MT group) and those without MT (CI - MT group) with regard to intraoperative complications (P = 0.760) and intraoperative findings (P = 0.545). MT association with total post-operative complications (GEE) showed no statistical significance (OR 2.45, 95% CI 0.83-7.22, P-value 0.105). CI + MT patients were significantly more likely to have inflamed middle ear mucosa at time of surgery (P = 0.003). CI + MT patients did not have a longer length of surgery compared to the CI - MT group (3.47 h vs 3.3 h, respectively, P = 0.342). CONCLUSION: Our data confirms it is safe to perform CI in ears with myringotomy tubes, although the surgeon should be aware of possibly encountering increased middle ear inflammation during the surgery.

Endoscopic Endonasal Transpterygoid Approach and the Need for Myringotomy.

OBJECTIVE: The expanded endonasal transpterygoid approach (EETA) is used to access the middle and posterior fossa through the pterygoid process. Traditionally, the eustachian tube (ET) was resected during EETA, which often required subsequent myringotomy for inner ear drainage. Anterolateral transposition of the ET was proposed to decrease potential morbidity associated with resection. However, a comparison of resection versus transposition regarding the need for subsequent myringotomy has not been reported. METHODS: This is a retrospective cohort study of patients who underwent an EETA. Patient demographics, tumor characteristics, management of ET with resection versus transposition, and need for subsequent myringotomy were collected. Analysis was performed with JMP software in standard fashion and univariate and multivariate logistic regression analysis performed with a p < 0.05 was considered significant. RESULTS: Ninety-one patients underwent EETA for various malignant and benign tumors. Twenty-seven patients required myringotomy, with tumors of the pterygopalatine fossa accounting for the most common location (n = 8). Malignant pathology had the highest myringotomy rate compared to benign tumors (48.9% vs. 10.9%, p < 0.001), as did receiving postoperative radiation (p < 0.001), ET resection (p < 0.001), and increasing CPK class. Multivariate analysis of these variables suggests that only ET resection significantly correlated with the need for myringotomy (LR 7.97, p = 0.005). CONCLUSIONS: ET resection during EETA can lead to ET dysfunction and require myringotomy post-operatively, and patients should be counseled of this risk. Radiation treatment, malignant pathology, and CPK class, all reflecting situations where more extensive surgery was needed, were associated with the need for myringotomy on univariate analysis but did not reach significance with multivariate analysis. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:1203-1207, 2024.

Adenoidectomy and Endoscopic Myringotomy with and without ventilation tube insertion for Treatment of Otitis Media with Effusion in 6-12 years old Children.

BACKGROUND: Otitis Media with Effusion (OME) is frequently caused by adenoiditis in children. OME is arguably one of the most common disorders that impairs hearing, speech development, and causes learning issues as a result. However, treatment options are debatable. AIM: This study aims to evaluate if inserting a ventilation tube in conjunction with adenoidectomy is significantly superior to adenoidectomy in conjunction with myringotomy alone in terms of hearing outcome in 6-12 years old children with OME. Patients and Methods: In this prospective controlled clinical study, 33 children; 66 ears, with ages ranging from 6-12 years (19 males and 14 females) diagnosed as cases of bilateral OME and varying degrees of adenoid hypertrophy were included. The patients were randomized into two groups; group I (17 patients; 34 ears) underwent adenoidectomy and endoscopic myringotomy alone, whereas the 16 patients;32 ears, in group II underwent adenoidectomy and endoscopic myringotomy together with ventilation tube insertion. Measurement of pure tone hearing threshold was achieved pre-operatively and at the end of 1st and 3rd postoperative months. The means of the pure tone hearing threshold averages of the patients in both groups were compared. Independent samples t-test was used to define the association between the two means. RESULTS: Pre-operatively, the means of pure tone hearing threshold averages were 27.3 ± 2.670 dB in group I patients and 29.5 ± 2.865 dB in group II patients. At the end of 1st and 3rd post-operative months, the pure tone hearing threshold average means in group I patients were 18.2 ± 2.689dB and 14.8 ± 2.735 dB respectively, while the means in group II patients were 10.6 ± 1.742 dB and 3.5 ± 1.158 dB respectively. Independent samples t-test revealed a statistically significant difference between group I and group II patients regarding the means of pure tone hearing threshold averages at the end of the 1st and the 3rd post-operative months (P value=0.015 and 0.003 respectively). CONCLUSION: In terms of hearing level, ventilation tube insertion in conjunction with adenoidectomy is statistically superior to adenoidectomy with myringotomy alone in the treatment of OME.

Balloon Eustachian Tuboplasty Combined or Not with Myringotomy in Eustachian Tube Dysfunction.

BACKGROUND: Eustachian tube dysfunction (ETD) is a common disorder causing ear pressure, pain, and hearing loss. Balloon Eustachian tuboplasty (BET) is an emerging technique for dilating the Eustachian tube and treating ETD. Whether adding myringotomy improves BET efficacy is controversial. METHODS: This retrospective study included 95 ETD patients undergoing BET alone (n = 44) or BET with myringotomy (BET + M; n = 51) between June 2020 and August 2021 at a single medical center. The primary outcome was the change in ETDQ-7 symptom scores from baseline to 6 months after treatment. Secondary outcomes included audiometry, endoscopy, Valsalva maneuver, and complications. RESULTS: The ETDQ-7 scores improved significantly after treatment in both groups (p < 0.001), without significant between-group differences (p = 0.417). No significant differences occurred in the audiometry, endoscopy, and Valsalva results or in most complications between groups. One BET + M patient had a persistent tympanic membrane perforation. CONCLUSIONS: Both BET alone and BET + M effectively and safely improved the subjective and objective ETD outcomes. However, adding myringotomy did not further improve the outcomes over BET alone, while it incurred risks such as persistent perforation. BET alone may sufficiently treat ETD without requiring myringotomy in this cohort. Further randomized controlled trials should identify optimal candidates for BET alone versus combined approaches.

Gathering validity evidence for a 3D-printed simulator for training of myringotomy and ventilation tube insertion.

Objectives: This study aimed to gather validity evidence according to Messick's framework for a novel 3D-printed simulator for myringotomy with ventilation tube insertion for use in technical skills training of otorhinolaryngology (ORL) residents. Methods: The study included 15 junior ORL residents (trainees) and 13 experienced teaching otolaryngologists (experts). Experts and trainees first received an identically structured introduction to the procedure, simulator, and simulation setup. Five procedures performed by each participant were video-recorded and ordered randomly for blinded rating by two independent raters. The rating tools used were a global rating scale (GBRS) and a task-specific checklist. Validity evidence was collected according to Messick's framework. Differences in time consumption and performance scores were analyzed. Finally, a pass/fail standard was established using the contrasting groups' method. Results: Trainees used significantly more time per procedure (109 s, 95% CI: 99-120) than experts (82 s, 95% CI: 71-93; p < .001). Adjusted for repetition and rater leniency, experts achieved an average GBRS score of 18.8 (95% CI: 18.3-19.2) out of 20 points, whereas trainees achieved an average of 17.1 points (95% CI: 16.6-17.5; p < .001). In contrast to the task-specific checklist, the GBRS score discriminated between repetition number and participant experience. The pass/fail standard for the GBRS was established at 18.4 points. Conclusion: We established educational validity evidence for a novel 3D-printed model for simulation-based training of ventilation tube insertion and established a reliable pass/fail standard. Level of Evidence: 1b.

Outcomes of in-office versus operating room insertion of tympanostomy tubes in children.

OBJECTIVE: Tympanostomy tube insertion in children is commonly performed under general anesthesia, but there has been increasing interest in office-based alternatives. Although initial research comparing in-office versus operating room (OR) insertion of tubes looks promising, there are scant data available on long-term outcomes. The objective of this study is to compare long-term outcomes of tympanostomy tubes placed in-office versus the OR, with emphasis on the duration of tube function. METHODS: We reviewed electronic medical records in an academic pediatric otolaryngology practice of children under age 13 years who had tubes placed in-office or the OR between 2010 and 2021. Differences in time to unilateral and bilateral tube occlusion/extrusion were compared by Kaplan-Meier survival analysis with log rank comparison. Cox regression modeling was performed to identify predictors of tube occlusion/extrusion. RESULTS: 817 children were included (473 office tubes, 344 OR tubes). Tube placement was equally successful for both groups (98.3% for office and 98.9% for OR). Comparison of Kaplan-Meier plots for time to unilateral and bilateral tube occlusion/extrusion by location showed no significant difference (P = .842 for unilateral and P = .714 for bilateral). However, regression analysis indicated a strong interaction of location with operator status (resident vs attending). Median time to unilateral occlusion/extrusion and bilateral occlusion/extrusion was shorter for OR residents compared to OR attendings (15.0 vs 19.5 months, P = .002, and 22.1 vs 32.0 months, P = .030, respectively). There was no difference in the time to unilateral or bilateral tube occlusion/extrusion between the office attending and OR attending groups (16.8 vs 19.5 months, P = .057 for unilateral, and 23.0 vs 32.0 months, P = .320 for bilateral). There was no significant difference between groups in the need for tube removal, repeat tubes, tube medialization, or post-extrusion tympanic membrane perforation. CONCLUSION: The comparable long-term outcomes found for tubes inserted in-office versus the OR, including time to occlusion/extrusion, suggest that both settings are acceptable for the procedure, with choice based primarily on parental preference, clinician experience, and shared decision making with families.

Can ChatGPT Guide Parents on Tympanostomy Tube Insertion?

BACKGROUND: The emergence of ChatGPT, a state-of-the-art language model developed by OpenAI, has introduced a novel avenue for patients to seek medically related information. This technology holds significant promise in terms of accessibility and convenience. However, the use of ChatGPT as a source of accurate information enhancing patient education and engagement requires careful consideration. The objective of this study was to assess the accuracy and reliability of ChatGPT in providing information on the indications and management of complications post-tympanostomy, the most common pediatric procedure in otolaryngology. METHODS: We prompted ChatGPT-3.5 with questions and compared its generated responses with the recommendations provided by the latest American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) "Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)". RESULTS: A total of 23 responses were generated by ChatGPT against the AAO-HNSF guidelines. Following a thorough review, it was determined that 22/23 (95.7%) responses exhibited a high level of reliability and accuracy, closely aligning with the gold standard. CONCLUSION: Our research study indicates that ChatGPT may be of assistance to parents in search of information regarding tympanostomy tube insertion and its clinical implications.

Impacts of health insurance on tympanostomy tube outcomes in the pediatric population.

OBJECTIVES: Tympanostomy tube (TT) placement is a common surgical procedure for treating pediatric patients with chronic otitis media with effusion (COME) with or without recurrent acute otitis media (rAOM). Prior work suggests children from low-income families face significant disparities in access to care for rAOM or COME. The impact of these health disparities in the care of children with rAOM or COME has yet to be investigated in a state with an expanded public health insurance model. We seek to examine differences in care for patients with rAOM and COME based on insurance status and socioeconomic status (SES) in Massachusetts. METHODS: Retrospective review of 560 pediatric patients referred for TT insertion at a tertiary academic medical center between 2017 and 2019. Demographic data collected included age, ethnicity, insurance type (public, private, none) and zip code. Otologic history collected included prior AOM episodes, time to postoperative follow-up, postoperative "no-show" appointments, and number of postoperative audiograms. Multinomial logistic regression was used to isolate the effects of race and ethnicity. RESULTS: We found no major differences in preoperative outcome measures between cohorts. Postoperatively, public insurance was independently associated with decreased odds of undergoing an audiogram (OR 0.35, 95% Cl 0.16-0.76) and increased odds of "no-showing" for an appointment (OR 3.1, 95% CI 1.8-5.3). SES was not independently associated with differences in postoperative outcomes. CONCLUSION: In a state with an early expanded public health insurance model, access to care for rAOM and COME is comparable despite differences in insurance type and SES. However, enrollment in public health insurance is associated with worse measures of follow up care. Despite improvements in access to care with expanded health insurance models, retention continues to be a challenge for vulnerable populations.

Case report of bilateral middle ear effusion requiring myringotomy and tube placement following inferior U-shaped nasopharyngeal flap elevation for endonasal odontoidectomy: investigation of causality.

We describe a patient with symptomatic os odontoideum and a previous history of C1-2 wiring who underwent successful treatment with a staged endonasal odontoidectomy and C1-2 revision of instrumentation. Access to the odontoid process was gained through the endonasal corridor using an inverted U-shaped nasopharyngeal flap (IUNF). Post-operatively, the patient experienced resolution of her presenting neurologic symptoms but developed conductive hearing loss secondary to bilateral middle ear effusion, requiring bilateral myringotomy and tube placement 3 months post-operatively. We hypothesize this dysfunction may have resulted from surgical edema, packing buttressing the IUNF, or some combination thereof. In this manuscript, we review the evolution of the nasopharyngeal exposure for odontoidectomy and whether an IUNF may predispose to this complication.

Ensuring tympanostomy tube follow-up during the COVID-19 pandemic.

OBJECTIVES: The impact of the COVID-19 pandemic on surgical practice was widespread. Local health restrictions in many communities limited the number and types of patients seen and treated. Our goal is to understand the discrepancies in follow-up for bilateral myringotomy with tubes (BMT) and understand whether the pandemic made it more difficult for certain patient populations to continue routine follow up. METHODS: This cross-sectional study abstracted demographic and clinical data from the medical charts of randomized pediatric patients who underwent a BMT procedure between 2017 and 2022 at a tertiary pediatric academic care center site. Suboptimal follow-up was defined as no clinic visits within the first 6 months of surgery, and less than 3 follow-ups within a 24-month period after surgery. Data regarding secondary surgeries, clinical variables, race, zip code, and dates and number follow-ups were recorded from randomly chosen eligible charts. Complications were defined as need for revision surgery or development of post-tympanostomy sequalae such as perforation, cholesteatoma, or granuloma. RESULTS: Pre-pandemic (N = 150) patients from 2017 to 2019 and post-pandemic (N = 150) patients from 2020 to 2022 cohorts were analyzed. No significant differences were identified between the groups regarding age, presence of combined surgery, anesthesia class, diagnosis, or race. There was no significant difference in rate of complications or need for revision surgery between either cohort nor when stratified for demographics. CONCLUSION: Limitations imposed upon medical care including outpatient clinics due COVID restrictions did not have an impact on tympanostomy tube follow-up regarding frequency of visits and risk of complication or revision surgery. LEVEL OF EVIDENCE: IV.

Pediatric cochlear implants and myringotomy tubes: a systematic review.

OBJECTIVE: To evaluate the intraoperative findings and post-operative complications associated with patients who have current or history of myringotomy tubes undergoing a cochlear implantation. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement were followed. Studies from Pubmed, Cochrane, Embase, Web of Science, and Scopus were included. Studies were independently screened and analyzed by 2 reviewers. Publications assessing pediatric patients with current or history of myringotomy tubes at time of cochlear implantation were reviewed. Discrepancies were resolved by a team of 4 reviewers. RESULTS: 172 studies were screened, 15 met inclusion criteria, and 12 were incorporated into the study. All 12 of the studies were retrospective cohort studies. Meta-analysis showed no significant relationship between intraoperative findings at time of cochlear implantation (presence of effusion, granulation tissue, edematous middle ear tissue) and myringotomy tube insertion (p = 0.63). Additionally, there was no significant relationship between current or history of myringotomy tube and acute otitis media episode after CI (p = 0.25). CONCLUSION: There was no association noted between perioperative outcomes of pediatric cochlear implantation and myringotomy tube. This information will be helpful for surgeons planning to perform cochlear implantation in the pediatric population.

Are rhinitis and Eustachian tube dysfunction associated in United States adolescents?

OBJECTIVES: Despite longstanding clinical gestalt of a relationship between rhinitis and Eustachian tube dysfunction (ETD), population-level evidence supporting this connection is lacking, particularly among adolescents. We aimed to investigate the association between rhinitis and ETD in a nationally-representative sample of United States adolescents. METHODS: We performed cross-sectional analyses of 2005-2006 National Health and Nutrition Examination Survey data (n = 1955, ages 12-19). Rhinitis (self-reported hay fever and/or nasal symptoms in the past 12 months) was stratified as allergic (AR) or nonallergic rhinitis (NAR) based on serum IgE aeroallergen positivity. History of ear disease and procedures was recorded. Tympanometry was classified by type (A, B, C). Multivariable logistic regression was used to test the association of rhinitis and ETD. RESULTS: Among US adolescents, 29.4% reported rhinitis (NAR 38.9%, AR 61.1%), and 14.0% had abnormal tympanometry. Adolescents with rhinitis were more likely to report a history of ≥3 ear infections (NAR: OR 2.40, 95% CI: 1.72-3.34, p < 0.001; AR: OR 1.89, 95% CI: 1.21-2.95, p = 0.008) and tympanostomy tube placement (NAR: OR 3.53, 95% CI: 2.07-6.03, p < 0.001; AR: OR 1.91, 95% CI: 1.24-2.94, p = 0.006), compared to those without rhinitis. There was no association between rhinitis and abnormal tympanometry (NAR: p = 0.357; AR: p = 0.625). CONCLUSION: NAR and AR are both associated with history of frequent ear infections and tympanostomy tube placement in US adolescents, supporting an association with ETD. This association is strongest for NAR, suggesting that specific inflammatory mechanisms may be involved in this condition and potentially explaining why traditional therapies for AR are largely ineffective for ETD.

Clinical Decision Making for Intraoperative Auditory Brainstem Response Testing in Children following Tympanostomy Tube Placement.

Intraoperative auditory brainstem response (ioABR) testing following tympanostomy tube (TT) placement may be biased due to temporary threshold shifts (TTS). The purpose of the study was to assess the evidence for TTS in children who have undergone ioABR using prolonged latencies of wave I (males > 1.95 ms, females > 1.88 ms) as a marker of a persisting air-bone gap. Eighty-three children underwent ioABR following surgical procedures at University Hospital Bonn, Germany. The primary outcome measure was the latency of wave I at 80-dB SPL. The total sample consisted of 66 males (79.5%) and 17 females (20.5%) with a mean (SD) age of 46.4 (26.6) months. Of 163 operated ears (83 children), 72 (44.2%) had no middle ear fluid, 19 (11.6%) serous fluid, and 72 (44.2%) mucoid fluid. The risk of having a prolonged latency of wave I at 80-dB SPL was OR 4.61 (95% CI 2.01-10.59; p < 0.001) in those with mucoid fluid as compared to those without mucoid fluid. Intraoperative ABR results should account for sex differences and be interpreted with caution and be verified. Ultimately, parents should be engaged in a preoperative discussion to decide if an ioABR should be postponed if mucoid fluid was found.

Effusion Prevalence at Tympanostomy During COVID-19: Follow-Up.

OBJECTIVE: We previously reported pandemic year (2020) intraoperative middle ear effusion (MEE) rate at time of bilateral myringotomy tube (BMT) placement was 18% lower compared to pre-pandemic year (2019). After mandatory stay at home orders (MSHO) and pandemic social distancing precautions were relaxed, we aimed to assess the impact of a persistent pandemic with new COVID-19 variants on MEE presence during BMT. METHODS: This study is a retrospective chart summary exempted by Nemours institutional review board at a single tertiary children's hospital. Children < 18 years who underwent BMT during March 1, 2019-June 31, 2019 (pre-COVID), March 1, 2020-June 31, 2020 (PY1), and March 1, 2021-June 31, 2021 (PY2) were included. Statistical analysis included chi-squared and KruskalWallis. RESULTS: A total of 1069 BMTs were reviewed: 551 (52%) during pre-COVID, 227 (21%) during PY1, and 291 (27%) during PY2. There were no significant differences in age, sex, or BMI across comparison groups. Intraoperative MEE was significantly higher pre-COVID (83%) compared to PY1 (65%) and PY2 (69%) (P < .001) despite a small rebound in PY2. CONCLUSION: Intraoperative MEE remains lower in subsequent pandemic years despite relaxed public health measures and may be impacted by persistent public health measures like masking, lower return to daycare, variable social distancing, and/or change to access to health care.

Laser, radiofrequency or tympanostomy knife? Comparison of surgical methods in tympanostomy treatment of young children and predictive value of tympanometry.

OBJECTIVES: To investigate tympanostomy tube (TT) treatment in young children, with special interest in bloodless surgical methods (laser and radiofrequency), myringosclerosis formation and tympanometric testing. METHODS: This prospective study includes 76 children whose 121 ears with middle ear effusion were treated with tympanostomy tubes. Myringotomy was performed with CO2 laser in 37, radiofrequency in 40 and myringotomy knife in 44 ears. The ears were evaluated with otomicroscopy and tympanometry preoperatively and postoperatively every 3-4 months until spontaneous tube extrusion. RESULTS: All tubes extruded spontaneously (mean 12.8 months, range 3-36 months), with no persistent perforations or cholesteatomas. CO2 laser and radiofrequency inserted tympanostomy tubes extruded faster (mean 11 months) compared to incisional myringotomy (mean 15 months, p = 0.002). Myringosclerosis was noted in 25 (21%) ears after treatment. There was a tendency to less myringosclerosis with bloodless techniques, but the difference was not significant. Flat tympanograms on the day of procedure predicted continuation of ventilation problems also after TT treatment (p = 0.003). Ears with preoperative type B tympanogram had significantly more myringosclerosis 21/75 (28%) compared with type A and C tympanograms 4/41 (10%) (p = 0.032). CONCLUSIONS: While all myringotomy methods were effective and safe, the traditional incisional myringotomy with a tympanostomy knife is still a good, feasible and cost-effective myringotomy method. No surgical removal of tympanostomy tubes is needed before 3 years of uncomplicated tympanostomy treatment. Tympanometry turned out to be a useful tool in prediction of post TT treatment ventilation problems of the middle ear.

An Overview of the Tympanostomy Tube.

Otitis media is a disorder of the middle ear, which can occur at any age but is more common among infants and children. The patient usually presents with earaches, impaired hearing, and fever. If antibiotics and decongestants do not suit the patient, a myringotomy can be performed to achieve middle ear aeration. In myringotomy, a slit is created in the tympanic membrane, and fluid is removed with suction. In cases where myringotomy, aspiration, and medical care don't help and the fluid recurs, a tympanostomy tube is inserted to create continuous aeration of the middle ear. A tympanostomy tube is a small tube inserted in the tympanic membrane which helps in the prevention of fluid accumulation in the middle ear. These tubes are temporary and often fall off after the ear heals. Other names for tympanostomy tubes are grommet, myringotomy tube, or pressure equalizing tube. Initially, tympanostomy tubes were made of metal but now fluoroplastic or silicone elastomers are used to make them. The two basic designs of a tympanostomy tube are short-term tube and long-term tube. The choice of a tympanostomy tube depends on factors like age, the period needed for ventilation, socioeconomic status, and the extent of the retracted eardrum. The incidence of occlusion, infection, functional duration, and persistent perforation following extrusion varies between the designs and materials. Every year, many children are affected by recurrent otitis media, which can negatively influence their quality of life and their ability to hear and communicate. With so many children requiring tympanostomy tubes, choosing the appropriate tube is vital to provide optimal treatment and limit complications.

[Different treatment methods and efficacy analysis of otitis media with effusion in children with different hearing loss].

Objective:To explore and analyze the treatment methods and effects of otitis media with effusion in children with different hearing loss. Methods:Clinical data of 318 children （556 ears） with otitis media with effusion（OME）admitted to Department of Otorhinolaryngology Head and Neck Surgery, Children Hospital Affiliated to Zhejiang University of Medicine from January 2020 to December 2021 were collected. Different treatment methods were selected according to the degree of hearing loss, combined with course of disease and the characteristics of effusion in tympanic cavity. They were divided into drug treatment group: critical hearing loss and mild hearing loss, and the course of disease was less than 3 months; myringotomy group: mild hearing loss and course of disease ≥3 months or moderate and severe hearing loss and course of disease<3 months, tympanic effusion was rarefied liquid; tympanostomy tube insertion group: mild hearing loss and course of disease ≥3 months, or moderate and severe hearing loss group and course of disease<3 months, tympanic effusion is sticky or jelly liquid, and moderate and severe hearing loss group and course of disease ≥3 months. 95% of children with adenoid hypertrophy or tonsillar hypertrophy and adenoid hypertrophy were diagnosed as obstructive sleep apnea hypopnea syndrome（OSA） and underwent endoscopic adenoidectomy or tonsillectomy and adenoidectomy. The curative effect and recurrence of different treatment groups were compared. Results:The drug treatment group and myringotomy group were followed up in 1, 3 and 6 monthes after operation. The tympanostomy tube insertion was followed up every three months after operation, with an average of one year. The patients were followed up in 1, 3 and 6 monthes after taking the tube off. The effective rates of drug treatment group, myringotomy group and tympanostomy tube insertion group were 95.6%, 89.6% and 90.9% respectively. The three groups recurred in 6, 4 and 5 ears respectively, and the difference was not statistically significant. Tympanic membrane perforation was left in 4 ears, 3 ears in tympanic tube group and 1 ear in myringotomy group. Multivariate Logistic regression analysis showed that allergic rhinitis（OR=0.073, 95%CI: 0.013-0.401, P=0.003） was the factor influencing the therapeutic effect of OME. Conclusion:the treatment of OME in children should not only be combined with course of disease, but also combined with different hearing loss and the characteristics of effusion in tympanic cavity. Different treatment methods can get the same effect, with low recurrence rate, small damage and satisfactory safety. Allergic rhinitis affects the therapeutic effect of OME.