Parental fatigue before and after ventilation tube insertion in their children.

OBJECTIVE: To determine if there is a difference in fatigue for caregivers of children with otitis media pre and post ventilation tube insertion (VTI). METHODS: Consecutive parents presenting with children at a pediatric otolaryngology practice at an academic medical center with recurrent otitis media who met criteria for VTI or who were following up within 6 weeks of VTI were surveyed with the Chalder Fatigue Scale (CFQ), a Visual Analogue Fatigue Scale (VAS-F), and demographic questions. RESULTS: No significant demographic differences were found (P < 0.05) in the preop versus postop groups. 101 parents participated, 88 mothers and 13 fathers. 59.4% were married or cohabitating, 18.8% were single, 10.9% were divorced, and 10.9% declined to answer. 45.5% were aged 18-29 years, 50.1% were 30-39 years, 2.9% were 40+ years, 1.0% declined to answer. 53.0% were college graduates. 46 (45.5%) were preop and 55 (54.5%) were postop. There were no statistical differences between these groups for age, gender, marital status, education level or number or children in the household. Mean VAS-F, with 0 being worst fatigue and 10 being normal, was 5.256 in the preop group and 6.777 in the postop group (p < 0.001). Mean CFQ, with higher numbers meaning worse fatigue, was 15.749 in the preop group and 11.804 in the postop group (p = 0.002). CONCLUSION: Parental fatigue can have significant effects on the family. Fatigue in parents whose children have otitis media has not been previously described. VTI for recurrent otitis media in children is associated with improved fatigue in their parents.

Decision Quality Among Parents Who Are Offered Ventilation Tube Insertion for Their Children.

OBJECTIVE: To develop a Decision Quality (DQ) tool to measure parents' DQ concerning ventilation tube (VT) insertion in their children. METHOD: Parental survey during 2017 to 2018 in a tertiary care pediatric otolaryngology clinic comparing a validated Decisional Conflict (DC) scale with a DQ instrument including Shared Decision-Making (SDM) scale, parental treatment goals, and knowledge about VT. RESULTS: Of 100 parent participants, 83% were mothers and 14% were fathers. 94% elected VT insertion, 6% elected monitoring or deferred the decision. 44% of the patients were <18 months, 42% were 19 months to 3 years, and the rest were older. The mean DC score was 8.26 out of 100 (95% CI 4.82-11.69), indicating low DC. Mean DQ score was 82.45 out of 100 (95% CI 80.18-84.72), including mean SDM of 87.71 (95% CI 83.53-91.88,), mean knowledge score of 87.5% (95% CI 84.56-91.59) and mean values score of 7.16 (95% CI 6.90-7.41). Comparisons between those who elected VT and those who did not showed that electors had lower DC scores (7.15 vs 24.74, P < .001), higher DQ scores (83.00 vs 72.61, P = .028) with higher SDM scores (88.70 vs 70.22, P = .044) and higher values score (7.20 vs 6.36, P = .034). Cronbach alpha for the DQ scale was 0.76. Spearman's rho for DQ score versus DC score was -0.458, P < .001. CONCLUSIONS: DQ, as measured with this tool, was higher when parents chose to place tubes. Our DQ instrument has potential use for study of why parents may decline VT when their child meets criteria for them.

Effects of early childhood otitis media and ventilation tubes on psychosocial wellbeing - A prospective cohort study within the Danish National Birth Cohort.

BACKGROUND: Otitis Media (OM) is one of the most common infections among children in developed countries and may result in temporary conductive hearing loss (HL) if accompanied by middle ear effusion (MEE). Ventilation tube insertion (VTI) is recommended as treatment for recurrent acute OM or chronic MEE with HL. HL may lead to impaired development of psychosocial skills. However, evidence for the developmental consequences of OM and the effect of VTI is inconsistent. The objectives of this study were to investigate 1) whether OM in early childhood is associated with long-term consequences of psychosocial development and 2) if VTI prevents the possible negative consequences of OM. METHODS: This study examined prospectively collected data from 52.877 children registered in the Danish National Birth Cohort (DNBC). Information about previous OM-episodes and VTI was obtained through systematic follow-up interviews at seven years, and The Strength and Difficulties Questionnaire (SDQ) containing questions about psychological wellbeing was completed. Five groups were defined based on OM-exposure and the presence of VTI. Baseline characteristics were analysed, and comparison of mean SDQ-scores for the five exposure groups was conducted. Means were adjusted for à priori defined confounding factors. RESULTS: Data from 52,877 children in the DNBC showed an association between OM and poorer SDQ-scores. VTI was associated with an additional increase, i.e. worsening, of the SDQ-score for boys, and only a slight beneficial effect on the girls' outcome. The groups differed in their baseline characteristics in e.g. maternal education, socio-economic status, breastfeeding, and prematurity. CONCLUSION: Significant associations between parent-reported OM in early childhood and later psychosocial health difficulties were found. VTI did not resolve this association.

Parent satisfaction and symptom relief in children with otitis media undergoing tympanostomy tube insertion.

INTRODUCTION: The objective of this study was to investigate parent satisfaction and symptom relief in children younger than 12 years undergoing tympanostomy tube (TT) insertion for otitis media (OM) using electronic patient-reported outcome (ePRO) data in private ear, nose and throat (ENT) practice settings. METHODS: A total of 3,553 children aged 0-11 years and registered in the Danish ENT Specialists Organisation (DØNHO) database were included. Following parental consent to participate, we e-mailed a pre-surgical questionnaire two days prior to surgery. Follow-up questionnaires were sent one, three, six, nine and 12 months after surgery. The pre-operative questionnaire collected information on symptom duration, number of acute OM (AOM) episodes within one year before TT insertion and ear-related symptoms. The post-operative questionnaires collected information on symptom relief, number of AOM episodes and parental satisfaction. RESULTS: Pre- and post-operative questionnaires from 2,462 children were eligible for complete analysis. Before surgery, 89.8% of parents reported a symptom duration of three months or longer and/or recurrent AOM (RAOM). Complete symptom regression was reported in more than half of the children post-operatively. For the rest, significant symptom relief was reported 1-12 months following TT insertion. Parent satisfaction rose from 94.8% to 97.2% in the course of the observation period. CONCLUSIONS: We report a consistent, high rate of symptom relief 1-12 months following TT insertion in children < 12 years of age. Furthermore, parental satisfaction throughout the 12-month observation period was compelling. FUNDING: none. TRIAL REGISTRATION: The database was approved by the Danish Data Protection Agency as a private, clinical database (no. 2016-42-3152). According to Danish law, approval by the Danish Research Ethics Committee system was not necessary.

Quality of life in Swedish children receiving grommets - An analysis of pre- and postoperative results based on a national quality register.

BACKGROUND: Otitis media with effusion (OME) and recurrent otitis media (rAOM) are two common diagnoses in childhood, both of which are treated with grommets, or ventilation tubes. It is known that affected children have a worse quality of life (QoL), and various questionnaires have been used to evaluate this. The national Swedish quality register for grommet insertions contains some QoL questions that have hitherto never been analysed. METHODS: Data from 2010 to 2016 was extracted from the register and analysed with regards to QoL questions, reasons for surgery, hearing levels and number of AOM episodes. RESULTS: Preoperative QoL data was available for 3835 children. Before surgery, most parents felt that the QoL of their children was negatively affected by the ear disease. Parents of children with OME were more likely to suspect that their child had a hearing loss (ORs 10.1 and 28.2 for suspecting a mild and severe hearing loss, respectively), but less likely to find that the ear disease affected the child's general wellbeing than did parents of children with rAOM (ORs 0.54 and 0.33 for somewhat and much affected, respectively). Many children underwent surgery despite not fulfilling the criteria for surgery as stipulated in the national guidelines. Those who did fulfil criteria, however, had a more severely affected QoL. A significant improvement was seen in individual QoL scores after surgery (p < 0.001). The degree of postoperative improvement in pure tone average correlated with the improvement in QoL (p < 0.001). CONCLUSION: This is the first time that the QoL aspect has been analysed in the Swedish grommet register. Though the validity of the questions has not been proven, they provide valuable information. The relevance of the surgical criteria in national guidelines is illustrated by their correlation with the QoL questions, particularly for OME, and the postoperative improvement in QoL suggests parents find that their children benefit from surgery.

The psychosocial impact of hearing aids in children with otitis media with effusion.

BACKGROUND: In children, otitis media with effusion is treated using grommets or hearing aids. Parents considering treatment options express concerns regarding the psychosocial impact of hearing aids in terms of self-esteem and bullying. This study assessed the psychosocial impact of hearing aid use. METHODS: A cross-sectional study was undertaken comparing hearing aid users to non hearing aid users with regard to their attitudes towards hearing aids. All subjects, who had been diagnosed with otitis media with effusion, were aged less than 16 years, were without disability and attended mainstream schools. A questionnaire was designed and utilised. RESULTS: The study comprised 47 children with hearing aids and 50 with grommets. Significant between-group differences (p < 0.05) were noted with regard to perceptions related to bullying, feelings of inadequacy and embarrassment. The overall negative perceptions of non hearing aid users were not reported by hearing aid users. CONCLUSION: Children with hearing aids do not suffer from bullying or low self-esteem to the extent perceived by parents. This information is useful for informed decisions regarding treatment of otitis media with effusion.

Validation of the German Glasgow children's benefit inventory.

OBJECTIVE: The aim of this study was to validate the German Glasgow Children's Benefit Inventory (GCBI) in children with different surgical interventions. MATERIAL AND METHODS: The GCBI was translated by using accepted forward-backward translation techniques and mailed to 741 parents whose children underwent either an otorhinolaryngological (n = 641) or an urological intervention (n = 100). The assessment was performed in a retrospective manner at the Medical University Innsbruck, Austria between January and March 2006. An exploratory principal component factor analysis with varimax rotation using factor loadings of >or=0.40 to allocate items to a scale was performed. Frequencies, means and standard deviations were used to describe patient, clinical, sociodemographic, and scale characteristics. RESULTS: The questionnaire was completed and returned by 325 patients (43.9%). The GCBI showed a high internal consistency (alpha = 0.84). The four-factor solution, emotional, vitality, learning and physical health explained 55.7% of variance. CONCLUSION: The German version of the GCBI was proven to be valid and reliable. It is suitable for subjective outcome analysis of different paediatric interventions from infants to adolescents.

Impact of tympanostomy tubes on child quality of life.

BACKGROUND: The objective benefits of tympanostomy tubes for otitis media are well established, but the subjective impact of surgery on child quality of life (QOL) has not been systematically studied. OBJECTIVES: To determine the subjective impact of tympanostomy tubes on child QOL, and to compare the variability in QOL before surgery with that observed after surgery. DESIGN: Prospective, observational, before-and-after trial. SETTING: Fourteen referral-based pediatric otolaryngology practices in the United States. PATIENTS: Consecutive (64%) and convenience (36%) sample of 248 children (median age, 1.4 years) with otitis media scheduled for bilateral tympanostomy tube placement as an isolated surgical procedure. INTERVENTION: Tympanostomy tubes were inserted as part of routine clinical care. Validated measures of QOL (OM-6 survey), satisfaction with health care decision (Satisfaction With Decision Scale), and satisfaction with office visit; surveys were completed at baseline (visit 1), at surgery (visit 2), and after surgery (visit 3). MAIN OUTCOME MEASURES: Short-term changes in QOL before surgery (visit 1 to visit 2) and after surgery (visit 2 to visit 3). RESULTS: Changes in QOL before surgery were mostly trivial, and were smaller than changes observed after surgery (P<.001). Large, moderate, and small improvements in QOL occurred after surgery in 56%, 15%, and 8% of children, respectively. Physical symptoms, caregiver concerns, emotional distress, and hearing loss were most improved, but significant changes were also seen for activity limitations and speech impairment. Trivial changes occurred in 17% of children, and 4% had poorer QOL. Predictors of poorer QOL were otorrhea 3 or more days (10% of variance) and decreased satisfaction with surgical decision (3% of variance). Hearing status, child age, type of otitis media (recurrent vs chronic), and office visit satisfaction were unrelated to outcome. CONCLUSIONS: Tympanostomy tubes produce large short-term improvements in QOL for most children. The best outcomes occur when postoperative otorrhea is absent or minimal, and when parents are satisfied with their initial decision to have surgery. Further research is needed to document the long-term impact of tubes on child QOL.

Grommets and patient satisfaction: an audit.

With the increasing role of evidence-based medicine we, as ENT surgeons, are being asked more and more to justify the practice of grommet insertion in children with glue ear. The audiological improvement which follows this operation is often only moderate at best. When judged solely in terms of hearing improvement, one may miss the often dramatic all-round improvement in a child which the parents frequently report to us postoperatively. We set out to confirm this clinical observation by using a retrospective questionnaire, seeking parental opinion after their children had undergone grommet insertion. We found a wide range of reported benefits as a result of grommet insertion; these include an improvement in hearing (92.1%), a reduced frequency of ear infections (74.1%), a reduction in postoperative GP visits (87%), less time missed from school (70.7%), as well as a variety of improvements in children's speech, education and general behaviour. Overall, we found that 96.7% of parents were satisfied that the decision to insert grommets in their child was correct. We feel that these non-audiological factors should be taken into account when judging the potential benefit to a child, or population of children, from grommet insertion.

Behavioural changes following routine ENT operations in two-to-ten-year-old children.

Behavioural changes in 85 two-to-ten-year-old children were evaluated by the parents one day, one week and one month after a routine ENT operation. Twenty (23%) children showed no changes. Behavioural problems at least once during the observation time were seen in 52 (61%) and improvements in 28 (33%) children, 15 (17%) had both. There was no statistically significant difference between the children treated as day cases and those hospitalized for one or two nights, or between the girls and the boys. The proportion of children showing behavioural problems decreased from 59% at 1 day to 32% at 1 month after the operation. The highest incidence of problematic changes occurred in children aged 3, 5 years or younger (79%), and the incidence was lowest in the 5.0-6.9-year-olds (43%). The most common changes were an increase in seeking attention from the parents (in 34% of the children), temper tantrums (25%), waking up at nights (16%) and problems in eating (16%).

The effects of early bilateral otitis media with effusion on educational attainment: a prospective cohort study.

The relationship between long-lasting, bilateral otitis media with effusion (OME) between the ages of 2 and 4 and educational attainment, in particular, reading and spelling ability at 7 years of age, was studied in a prospective cohort study of 946 children. After selection, three groups were distinguished: 151 children with long-lasting, bilateral OME at preschool age, 37 preschool children treated with ventilation tubes, and 82 children with no history of OME at that age. Early bilateral OME was found to affect spelling ability, but not reading ability, at 7 years. The effects of OME did not appear to increase with the number of observations of OME. Also, recurrent hearing loss did not have more detrimental effects than continuous hearing loss. Effects of treatment with ventilation tubes were not found. Only the teachers' ratings of writing ability indicated a slight advantage of treatment with ventilation tubes. In conclusion, the educational consequences of early OME appear to be very small.

The effects of ventilation tube placement on hearing, speech, language, cognition and behaviour.

As a part of a larger, multidimensional study on secretory otitis media (SOM) and its relation to children's development, the effects of ventilation tube (VT) placement on hearing, speech, language, cognition and behaviour were studied over a six month period. Children with a clear and persistent picture of SOM were examined just before tubes were inserted and again, with the same measures, six months later. Their evolution was compared to that of a control group. The results indicate, as was expected, that the hearing of the children with SOM normalized very quickly after surgery. Speech and expressive language functions were comparable for both groups at the two moments of examination. Only verbal comprehension of the SOM-group was found to be slightly improved in the course of a six month period. No differences in general cognitive functioning and in behaviour were found between both groups.

Child distress during hospitalization: implications for practice.

This paper investigates distress in 221 children admitted to a district general hospital for ENT surgery. Younger children (5 years and under) were rated by nurses as being most distressed, with girls more so than boys. Presence of a parent in hospital overnight is also found to be associated with higher levels of distress. It is suggested that preparation programmes designed to reduce distress should target younger children and that consideration be given to a preparation programme for parents.

Same-day surgery preparation: reduction of pediatric patient arousal and distress through participant modeling.

Twenty-six children (mean age = 5.5 years) were exposed to one of three surgery preparatory conditions: participant modeling alone (n = 9), participant modeling with mother (n = 8), and standard procedure control (n = 9). Children exposed to the modeling slide-tape without their mothers had significant reductions in physiological arousal after the slide-tape presentation, unlike children viewing the tape with their mothers and children exposed to the control condition. Both participant modeling groups exhibited significantly fewer distressful behaviors during recovery (postsurgery) than did control group children. Results are discussed with respect to previous medical preparation research. Implications of these findings concerning clinical application and future research are addressed.

Same day surgery: a preschooler's experience.

This case study of a 4-year-old boy describes his coping behaviors during admission for myringotomy and polyethylene tube insertion as a same day surgery patient. Nursing care provided the child with the opportunity to "play out" feelings aroused by the experience as a surgical patient. The child's behavior indicated that the planned and supportive responses of the nurse caring for him promoted the child's sense of mastery and self-confidence.