Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-26T14:03:56.915Z Has data issue: false hasContentIssue false
  • English
  • Français

Ventilation tube non-function due to blockage in children: the frequency, course and effect on hearing. A prospective cohort study

Published online by Cambridge University Press:  04 December 2020

M Merven ,
J W Loock  and
G G Browning
M Merven*
Affiliation:
Department of Otorhinolaryngology, Tygerberg Hospital, Faculty of Health Sciences, University of Stellenbosch, Cape Town, South Africa
J W Loock
Affiliation:
Department of Otorhinolaryngology, Tygerberg Hospital, Faculty of Health Sciences, University of Stellenbosch, Cape Town, South Africa
G G Browning
Affiliation:
Otorhinolaryngology and Head and Neck Surgery, University of Glasgow, Scotland, UK, affiliated with Medical Research Council/Chief Scientist Office (‘MRC/CSO’) Institute of Hearing Research, Glasgow, Scotland, UK
*
Author for correspondence: Dr Marc Merven, Division of ENT Surgery (Otorhinolaryngology), Tygerberg Hospital, Faculty of Health Sciences, University of Stellenbosch, Francie Van Zyl Street, Cape Town, South Africa E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To assess the effect on hearing of non-functioning ventilation tubes due to blockage during the first six months post-operatively, using UK national guidelines.

Method

A prospective, observational study was conducted on 37 children who underwent bilateral ventilation tube insertion. Air and bone conduction thresholds were measured before and following surgery, and at one, three and six months post-operatively. Tube non-function was assessed by tympanometry supported by otoscopy.

Results

Post-operatively, an average of 21 per cent of ventilation tubes were non-functioning. Ears with non-functioning tubes had significantly (p = 0.0001) poorer mean air conduction thresholds than functioning tubes, with a magnitude of 6 dB HL. Ears with otorrhoea were most affected (15 per cent). At any one visit, the air–bone gap was closed to 10 dB or less in 76 per cent of ears. Non-functioning tubes reduced this to 56 per cent. Compared with tympanometry, otoscopy underdiagnosed tube non-function due to blockage by 22 per cent.

Conclusion

Non-functioning of ventilation tubes occurs frequently and can be missed on otoscopy. Although it is associated with poorer air conduction thresholds, the magnitude of this difference is unlikely to warrant further intervention unless there is otorrhoea or recurrence of bilateral hearing impairment.

Keywords

Middle Ear VentilationGrommet InsertionPatencyHearing OutcomeMiddle Ear EffusionOtitis Media With Effusion
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 12 , December 2020 , pp. 1052 - 1059
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr M Merven takes responsibility for the integrity of the content of the paper

References

Browning, GG, Rovers, MM, Williamson, I, Lous, J, Burton, MJ. Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev 2010;(10):CD00180Google Scholar
Kay, DJ, Nelson, M, Rosenfeld, RM. Meta-analysis of tympanostomy tube sequelae. Otolaryngol Head Neck Surg 2001;124:374–80CrossRefGoogle ScholarPubMed
MRC Multicentre Otitis Media Study Group. The role of ventilation tube status in the hearing levels in children managed for bilateral persistent otitis media with effusion. Clin Otolaryngol Allied Sci 2003;28:146–53CrossRefGoogle Scholar
Zielhuis, GA, Rach, GH, van den Basch, A, van den Broek, P. The prevalence of otitis media with effusion: a critical review of the literature. Clin Otolaryngol Allied Sci 1990;15:283–8CrossRefGoogle ScholarPubMed
MRC Multicentre Otitis Media Study Group. An extension of the Jerger classification of tympanograms for ventilation tube patency – specification and evaluation of equivalent ear-canal volume criteria. Ear Hear 2008;29:894–906CrossRefGoogle Scholar
Hellström, S, Groth, A, Jörgensen, F, Pettersson, A, Ryding, M, Uhlén, I et al. Ventilation tube treatment: a systematic review of the literature. Otolaryngol Head Neck Surg 2011;145:383–95CrossRefGoogle ScholarPubMed
Syed MI, Suller, Browning, GG, Akeroyd, MA. Interventions for the prevention of postoperative ear discharge after insertion of ventilation tubes (grommets) in children. Cochrane Database Syst Rev 2013;(4):CD008512Google Scholar
Rovers, MM, Black, N, Browning, GG, Maw, R, Zielhuis, GA, Haggard, MP. Grommets in otitis media with effusion: an individual patient data meta-analysis. Arch Dis Child 2005;90:480–5CrossRefGoogle ScholarPubMed
MRC Multicentre Otitis Media Study Group. Adjuvant adenoidectomy in persistent bilateral otitis media with effusion: hearing and revision surgery outcomes through 2 years in the TARGET randomized trial. Clin Otolaryngol 2012;37:107–16CrossRefGoogle Scholar
Rosenfeld, RM, Schwartz, SR, Pynnonen, MA, Tunkel, DE, Hussey, HM, Fichera, JS et al. Clinical practice guideline: tympanostomy tubes in children. Otolaryngol Head Neck Surg 2013;149:S1–35CrossRefGoogle ScholarPubMed
American Academy of Pediatrics. Follow-up management of children with tympanostomy tubes. Paediatrics 2002;109:328–9CrossRefGoogle Scholar
Verkerk, M, Fishman, JM, Browning, GG, Schilder, AGM. Interventions for the prevention of postoperative grommet (ventilation tube) obstruction. Cochrane Database Syst Rev 2015;(5):CD011685Google Scholar