Letteratura scientifica selezionata sul tema "Tympanostomy tube insertion"

Objectives: With tympanostomy tube insertion remaining the most common procedure performed in children to date, growing interests in minimizing both procedural costs and anesthetic exposure in the pediatric population have inspired innovation with respect to tympanostomy tubes. As such, we aim to discuss the current state of tympanostomy tube innovation including insertion devices, tube material, and design. Methods: Computerized literature review. Results: (1) Numerous single-use devices consisting of a myringotomy knife and preloaded tympanostomy tube offer potential advantages of decreasing or eliminating operating room time and may be performed under moderate instead of a general anesthetic. (2) Innovation with respect to tympanostomy tube material and design may offer enhanced ototopical drug delivery, decreased rates of tube occlusion, and/or the ability to dissolve “on-command” with application of a novel ototopical material. (3) These technologies currently remain in various phases of preclinical and clinical testing. Conclusions: While clinical testing for a number of new technologies is preliminary and ongoing, tympanostomy tube-related innovations hold exciting promise to supplement or potentially replace the present-day armamentarium of tympanostomy tube design and insertion moving forward.

Objective: To develop a simple, portable, inexpensive model for otolaryngology trainees to practice on and develop skills required for myringotomy and tympanostomy tube insertion. Materials and Methods: Recycled plastic egg crate, a 3-cc plastic syringe, micropore™ tape and modeling clay were used to create a model to practice myringotomy and tympanostomy tube insertion utilizing tubes fashioned from a recycled 18 guage intravenous catheter. Result: The model myringotomy practice set is an inexpensive, simple do-it-yourself device made of locally available, mostly recycled materials. Key words: myringotomy practice set, myringotomy, middle ear ventilation, tympanostomy, tympanostomy tube insertion, instrumentation

AbstractObjective:We present a rare case of perilymphatic fistula which occurred due to bony erosion by a tympanostomy tube that had migrated into and become interred in the middle-ear space.Method:We present a case report and a literature review concerning migration of tympanostomy tubes into the middle ear as a complication of tubes insertion.Conclusion:Medial migration of tympanostomy tubes into the middle-ear space is a rare complication of tympanostomy tubes insertion. To our knowledge, this is the first report of perilymphatic fistula caused by a tympanostomy tube which had migrated into the middle ear. This case highlights the need for early removal of tympanostomy tubes which migrate into the middle ear.

Objectives To discover whether tubes coated with antibiotic ointment can prevent the complication of post-tympanostomy tube otorrhea. Methods Retrospective chart analysis was done of the last 344 consecutive ears for tube surgery without ointment, and tube surgery with ointment, from Dec. 2006 to Oct. 2007. Only surgery using 7mm flouroplastic tubes were reviewed. Results A total of 128 ears had no ointment during the operation. Of the 128 ears, 12 ears developed otorrhea within 1 week, or an incidence of 9.4%. A total of 216 ears had antibiotic ointment coated onto the fluoroplastic tube during the operation and at time of tube insertion. Of the 216 ears, 7 ears developed post-tympanostomy tube otorrhea within 1 week, or an incidence of 3.2%. Our analysis using the chi-square test was statistically significant, with a p value of 0.02. Conclusions Post-tympanostomy tube otorrhea is a frequent complication of tympanostomy tube insertion, but by coating the tube with an antibiotic ointment at the time of surgery, we can decrease that incidence from 9.3% to 3.2%.

AbstractA total of 305 children, five to 16 months of age, were treated from 1983–1984 with ventilation tubes – Shah vent Teflon tube – inserted under local anaesthesia for recurrent acute otitis media (RAOM) or otitis media with effusion (OME). The final study group comprised 281 children (92.1 per cent) monitored prospectively for five years, 185 in the OME-group and 96 in the RAOM-group. For the first insertion of tubes the average ventilation period was 15.4 months. Re-tympanostomy, with adenoidectomy simultaneously at the first time was performed in 99 ears (35.2 per cent); once in 27.0 per cent, twice in five per cent, and three times in 3.2 per cent. Mastoidectomy due to otorrhoea was performed in three ears (1.1 per cent). The children in the OME-group were at higher risk of repeated post-tympanostomy otorrhoea episodes than children in the RAOM-group. These episodes of otorrhoea during the first insertion of ventilation tubes significantly increased both the tube extrusion rate and the need for subsequent re-tympanostomies. No major complications were caused by the tympanostomy procedure as such. It is concluded that early tympanostomy is a safe procedure in young children with RAOM or OME. However, parents should be carefully informed of risks of post-tympanostomy otorrhoea and recurrent disease after insertion of ventilation tubes necessitating subsequent tube insertion, especially in children with OME.

Objective: To describe a novel harpoon design for a low cost, self retaining tympanostomy tube with applicator used in a 38-year-old female for otitis media with effusion. Methods: Study design: Instrumental Innovation/Case Report Setting: Tertiary Hospital in Metro Manila Results: The tympanostomy tube was inserted under endoscopic guidance within 10 seconds, remained in place for two months with relief of symptoms, and spontaneously extruded by the seventh month of follow-up. Conclusion: The harpoon-designed tube with applicator provided ease of insertion and good anchorage in the tympanic membrane. Maximizing the use of a stylet-needle as both perforator and applicator simplified the tympanostomy and ventilating tube insertion procedures into a single maneuver. Key words: middle ear ventilation, tympanostomy tube insertion, grommet insertion, instrumentation

Objectives The purpose of this report is to relate a single institution's experience with middle ear disease and the incidence and efficacy of tympanostomy tube (PET) insertion in children with Down syndrome. Methods Retrospective chart review of 130 consecutive pediatric Down syndrome patients seen at a single tertiary care children's hospital between the years 2001–2007. Middle ear function, and speech and language development, is reported and those patients who underwent tympanostomy tube insertion for middle ear disease are analyzed. Results The mean age of the patient population was 4.5 years, ranging from 8 months to 10 years. 41/130 patients (31.5%) were treated with tympanostomy tube insertion for middle ear disease. Of this group, 11/41 patients (26.8%) and 2/11 patients (18.1%) required second and third tube insertions, respectively, for persistent pathology and failed tube function. The mean age at first tube insertion was 3.3 years, while the mean age at second and third tube insertion was 6.9 and 6.0 years. Outcome measures included a documented conductive hearing loss on audiological assessment and/or persistent middle ear effusion on physical exam. Speech and language skills were also assessed. Conclusions Children with Down syndrome have an increased incidence and persistence of middle ear disease. Additionally, affected children may require multiple surgical interventions for persistent disease and failed tube function. The multiple medical problems often associated with Down syndrome result in an increased anesthetic risk for these patients. Therefore, we propose the utility of a durable tympanostomy tube for more efficient treatment and the avoidance of multiple interventions.

Tympanostomy tube insertion and tympanic membrane incision are two the most frequently performed surgical procedures in otolaryngology, especially in children. The tympanic membrane incision - paracentesis, or myringotomy – is an incision of the tympanic membrane for diagnostic purposes or to allow drainage of pathological secretion from the tympanic cavity. Tympanostomy tube insertion involves incision made in the tympanic membrane and insertion of a ventilation tube (various types and for various periods of time) to improve hearing and aeration of the tympanic cavity. Procedures are performed through the ear canal (transcanal approach), under local or general anesthesia. Complications may occur in some cases of paracentesis and tympanostomy tube insertion.

Objective. To investigate the impact of seven-valent pneumococcal conjugate vaccine on tube insertions in a partial immunized pediatric population.Study Design. Retrospective ecological study.Methods. This study used Taiwan National Health Insurance Research Database for the period 2000–2009. Every child under 17 years old who received tubes during this 10-year period was identified and analyzed. The tube insertion rates in different age groups and the risk to receive tubes in different birth cohorts before and after the release of the vaccine in 2005 were compared.Results. The tube insertion rates for children under 17 years of age ranged from 21.6 to 31.9 for 100,000 persons/year. The tube insertion rate of children under 2 years old decreased significantly after 2005 in period effect analysis (β= −0.074,P< 0.05, and the negativeβvalue means a downward trend) and increased in children 2 to 9 years old throughout the study period (positiveβvalues which mean upward trends,P< 0.05). The rate of tube insertion was lower in 2004-2005 and 2006-2007 birth cohorts than that of 2002-2003 birth cohort (RR = 0.90 and 0.21, 95% CI 0.83–0.97 and 0.19–0.23, resp.).Conclusion. The seven-valent pneumococcal conjugate vaccine may reduce the risk of tube insertion for children of later birth cohorts. The vaccine may have the protective effect on tube insertions in a partial immunized pediatric population.

Children younger than 7 years are at increased risk of otitis media because of their immature immune systems and poorly functioning eustachian tubes that normally ventilate the middle ear space and equalize pressure with the external environment. More than 80% of children have at least one episode of acute otitis media (AOM) before the age of 3 years and 40% experience six or more recurrences by the time they are 7 years old.1 By the age of 3 years, approximately 7% of children undergo surgery for tympanostomy tube insertion for a range of otitis media issues, most commonly for chronic otitis media with effusion (OME), recurrent acute AOM, and acute otitis media that persists despite antibiotic therapy.2 However, tympanostomy tube insertion is associated with risks and remains a controversial practice especially in children with OME of less than three months’ duration and in children with recurrent AOM. Adverse effects associated with tympanostomy tube insertion include those associated with anaesthesia and its complications (laryngospasm, bronchospasm), as well as tube related sequelae such as recurrent (7%) or persistent (16–26%) otorrhoea, blockage of the tube lumen (7%), granulation tissue (4%), premature extrusion of the tube (4%), tympanostomy tube displacement into the middle ear (0.5%) and persistent perforation of the tympanic membrane (1%–6%).3 This article offers guidance for family practitioners wishing to optimize health outcomes in children potentially requiring tympanostomy tube placement.

Tonsillectomy, adenoidectomy and myringotomy are the most common surgical procedures undergone by children. Medical opinion regarding the appropriateness of these procedures remains contentious, and considerable resources have been expended in the formulation and distribution of relevant practice guidelines. The impact of this surgery on the child, community and private and public health resources is considerable, yet there has been little examination of surgery rates and trends, or of the characteristics of children who undergo surgery. This thesis addressed five major questions regarding this surgery in New South Wales, Australia. The first three related to population rates: the level of surgery among NSW children, comparability with international rates, trends over time and the effect of guidelines. Comprehensive hospital data between 1981 and 1999 were analysed. Major findings were a higher myringotomy rate in NSW than reported internationally, the short-term effect of guidelines, and a major shift towards children having surgery at a younger age. The remaining questions asked whether children who had surgery differed from other children in their use of health services prior to surgery, and if so, whether their utilization reverted to the norm following surgery. Matched records of a population cohort of 6239 NSW children, born during January 1990, were extracted from Health Insurance Commission data, and their claims for medical services followed retrospectively from birth to 8 years. Children who had privately funded surgery were found to use more medical services than other children, and, most unexpectedly, this did not change following surgery. The results suggest potential non-clinical factors influencing this excess utilization. This is the first population study to examine health service utilisation by these children and it has identified an important new risk factor for surgery.

博士
國立陽明大學
公共衛生研究所
103
Part 1 The Protective Effect of Adenoidectomy on Pediatric Tympanostomy Tube Re-insertions: A Population-Based Birth Cohort Study Objectives: Adenoidectomy in conjunction with tympanostomy tube insertion for treating pediatric otitis media with effusion and recurrent acute otitis media has been debated for decades. Practice differed surgeon from surgeon. This study used population-based data to determine the protective effect of adenoidectomy in preventing tympanostomy tube re-insertion and tried to provide more evidence based information for surgeons when they do decision making. Study Design: Retrospective birth cohort study Methods: This study used the National Health Insurance Research Database for the period 2000-2009 in Taiwan. The tube reinsertion rate and time to tube re-insertion among children who received tympanostomy tubes with or without adenoidectomy were compared. Age stratification analysis was also done to explore the effects of age. Results: Adenoidectomy showed protective effects on preventing tube re-insertion compared to tympanostomy tubes alone in children who needed tubes for the first time (tube re-insertion rate 9% versus 5.1%, p=0.002 and longer time to re-insertions, p=0.01), especially those aged over 4 years when they had their first tube surgery. After controlling the effect of age, adenoidectomy reduced the rate of re-insertion by 40% compared to tympanostomy tubes alone (aHR: 0.60; 95% CI: 0.41-0.89). However, the protective effect of conjunction adenoidectomy was not obvious among children with a second tympanostomy tube insertion. Children who needed their first tube surgery at the age 2-4 years were most prone to have tube re-insertions, followed by the age group of 4-6 years. Conclusions: Adenoidectomy has protective effect in preventing tympanostomy tube re-insertions compared to tympanostomy tubes alone, especially for children older than 4 years old and who needed tubes for the first time. Nonetheless, clinicians should still weigh the pros and cons of the procedure for their pediatric patients. Part 2 Impact of Seven-Valent Pneumococcal Conjugate Vaccine on Pediatric Tympanostomy Tube Insertions in A Partial Immunized Population: A Population Based Study Objectives: The seven-valent pneumococcal conjugate vaccine has been effective in preventing invasive pneumococcal disease in children and has indirect effects on unvaccinated individuals in different age groups. The vaccine also decreases the incidence of otitis media and tympanostomy tube procedures in children. However the indirect effect of the vaccine on tube insertions has seldom been mentioned. The vaccine was released in Taiwan in 2005. We examined the impact of the vaccine on tube insertions in a partially immunized pediatric population. Study Design: Retrospective ecological study Methods: This study used the Taiwan National Health Insurance Research Database for the period 2000-2009. Every child under 17 years of age who had received tubes during this 10-year period was identified and analyzed. The tube insertion rates in different age groups, before and after the year 2005, and the risk to receive tubes in different birth cohort were compared. Results: The tube insertion rate of children under 2 years of age decreased significantly after 2005 in period effect analysis and increased in children 2 to 9 years of age throughout the study period. However, the decreasing trend of tube insertion rate seemed to be begun in 2003. The risk of tube insertion was lower in 2004-2005 and 2006-2007 birth cohorts than that of 2002-2003 birth cohort. Conclusions: The seven-valent pneumococcal conjugate vaccine may reduce the risk of tube insertion for children of later birth cohorts in comparison with 2002-2003 birth cohort. This effect may be due to the direct effect or both direct and indirect effect of the vaccine. There was no obvious indirect effect of the vaccine on tube insertions in children older than 2 years of age.