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To analyze otologic features in patients with primary ciliary dyskinesia (PCD) aged 0 to 18 years and to evaluate the correlation between ultrastructural defects and severity of otologic features.Retrospective study.Pediatric referral center.Fifty-eight patients with PCD were evaluated in the following 4 age intervals: group 1, preschool (≤ 5 years [n = 47]); group 2, school (6-11 years [n = 50]); group 3, teenagers (12-17 years [n = 34]); and group 4, young adults (≥ 18 years; 27 years for the oldest [n = 10]). Follow-up was 2 to 6 years in each age group; 26 patients had total follow-up of more than 12 years. Ultrastructural defects occurred in the outer dynein arm (n = 33), the inner dynein arm (n = 13), and the central complex (n = 11). One patient had typical Kartagener syndrome with typical PCD features but normal ciliary ultrastructure.Frequency of acute otitis media, otitis media with effusion, otorrhea, chronic otitis media, hearing loss, and middle ear surgery and type of antibiotic regimen according to age and type of defect.Recurrent acute otitis media decreased from group 1 (32 of 47 [68%]) to group 4 (0 of 10 [0%]) (P.001). Otitis media with effusion was more severe in groups 1 through 3 than in group 4 (P = .02). Otorrhea decreased in group 4: 30% vs 80% (3 of 10 vs 36 of 41) in the other groups (P.001). Half of the patients with tympanostomy tubes eventually had tympanic perforation. Hearing loss was moderate in groups 1 through 3 and mild in group 4. Continuous antibiotic therapy could be slightly reduced only in group 4. Central complex defect was a significant marker of severity for all these criteria.Despite continuous antibiotic therapy, the middle ear condition in PCD remained severe throughout childhood, with improvement only after age 18 years. Armstrong grommet placement did not improve the middle ear condition. Central complex defect is a marker of severity.

Objectives: To validate the 6-item quality-of-life survey (OM-6) and to investigate response-shift bias regarding children with otitis media.Setting: Otorhinolaryngology department of a university hospital that serves the southernmost part of the Netherlands.Patients: Seventy-seven children (age range, 12-38 months) experiencing persistent otitis media with effusion and scheduled for placement of tympanostomy tubes.Survey: The OM-6 measures health-related quality of life in 6 domains: physical suffering, hearing loss, speech impairment, emotional distress, activity limitations, and caregiver concerns.Intervention: Parents completed the OM-6 before surgery (pretest) and 6 weeks after surgery (posttest). At the posttest, parents also completed a retrospective version of the pretest (retrospective pretest).Results: For most items, the test-retest reliability was good (R > 0.8). The internal consistency of the OM-6 was satisfactory (alpha = .79). The construct validity, determined by correlating the ear-related global quality-of-life measure and the OM-6 summary score, was fair (R = -0.77, P < .01). Prospective change in quality of life on the OM-6 ranged from moderate (standardized response mean greater than or equal to 0.5) to large (standardized response mean greater than or equal to 0.8). Response-shift bias was present at the group level (t = -3.3, P < .01). Retrospective change was significant for hearing loss (z = -3.3, P < .05) and ear-related global quality of life (z = -3.6, P < .05).Conclusions: The validity of the OM-6 has been proved in a Dutch population. The data suggest that parents underestimate the seriousness of hearing loss and overestimate the quality of life of their child before surgery, indicating a response shift. Treatment results could lead parents to realize that the situation before surgery had been worse than they thought.

Objective To determine incidence and prevalence of middle ear sequelae and abnormal tympanometry results among children with chronic otitis media with effusion (OME) who received standard treatment with tympanostomy tubes. Design Prospective cohort study. Setting Community clinic and academic medical center. Patients A total of 140 children followed up for 8 years after tube treatment. Main Outcome Measures Tympanic membrane perforation, atrophy, retraction, hearing loss, myringosclerosis, low static admittance (SA) and broad-peaked tympanogram, high SA and narrow-peaked tympanogram, and negative tympanometric peak pressure. Results Annual incidence of sequelae was typically greater during 3 to 5 years than 6 to 8 years of follow-up. Greatest increases in incidence during the 5-year follow-up were for atrophy (67%), high SA and narrow-peaked tympanogram (70%), and retraction pocket (47%). Prevalence of these sequelae also increased over time, whereas low SA and broad-peaked tympanogram and negative tympanometric peak pressure decreased during follow-up. Sequela tended to become bilateral over time, and concordance of different sequelae in the same ear was low (κ, 0.05-0.42). Conclusions Annual incidence of sequelae decreased during follow-up. This finding parallels decreasing incidence of OME and tube placement as children mature and demonstrates that sequelae are more likely to develop during active acute and chronic OME. The cumulative effect of incidence resulted in few ears free of sequelae by 8 years of follow-up. Based on this cohort of healthy children with OME, although the risk of sequelae decreased over time, functional and morphologic sequelae were prevalent and may put children at risk for continuing middle ear problems as they grow into adolescence and adulthood.

Background Infrared tympanic thermometry (ITT) is often used for postoperative recovery room monitoring regardless of recent minor otologic surgery. Objective To evaluate the use of ITT in pediatric patients who have undergone bilateral myringotomy with insertion of pressure-equalizing tubes. Design A prospective cohort study. Setting Tertiary care academic medical center. Patients Consecutive patients of a staff pediatric otolaryngologist (M.A.R.): (1) ear surgery group, children aged 10 years or younger undergoing bilateral myringotomy with insertion of pressure-equalizing tubes and (2) non–ear surgery group, children aged 10 years or younger undergoing bilateral tonsillectomy with or without adenoidectomy. Interventions Immediate preprocedure temperature measurements included right and left ear ITT. Immediate postprocedure temperature measurements included right and left ear ITT and thermistor probe rectal temperature. Main Outcome Measures The average difference between the preprocedure and postprocedure tympanic temperature in the ear surgery group was compared with that in the non–ear surgery group. The average difference between postprocedure rectal and ear temperature in the ear surgery group was compared with that in the non–ear surgery group. Results There were 20 patients (40 ears) in the ear surgery group and 20 patients (40 ears) in the non–ear surgery group. In the ear surgery group, the average difference between the preprocedure and postprocedure tympanic temperature (0.55°C) was not significantly different from that (0.62°C) in the non–ear surgery group ( P = .66, 1-way analysis of variance). In the ear surgery group, the average difference between postprocedural rectal and ear temperature (1.94°C) was not significantly different from that (1.89°C) in the non–ear surgery group ( P = .76, 1-way analysis of variance). Conclusion Recent minor ear surgery (bilateral myringotomy with insertion of pressure-equalizing tubes) does not have a significant effect on ITT measurements in pediatric patients.

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.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.Prospective, observational, before-and-after trial.Fourteen referral-based pediatric otolaryngology practices in the United States.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.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).Short-term changes in QOL before surgery (visit 1 to visit 2) and after surgery (visit 2 to visit 3).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.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.

Objectives To determine the incidence of cholesteatoma formation associated with ventilation tube (VT) placement and to identify and analyze the variables and risk factors that may predict or predispose to this complication. Design We reviewed the medical records of 2829 children following VT insertion between the years 1978 and 1997 to obtain 1- to 20-year follow-up data. Setting Departments of Otolaryngology–Head and Neck Surgery and outpatient clinics of 2 tertiary referral academic medical centers. Patients A study population of 2829 children, ranging in age from 1.2 to 14 years (5575 ears), underwent a total of 6701 VT placements. Main Outcome Measure Cholesteatomas were considered a complication of VT placement whenever they developed at or near the site of the tube insertion. Results Cholesteatomas directly attributed to VT placement occurred in 1.1% of the ears that were operated on. A higher incidence occurred (1) in children younger than 5 years, (2) when Goode T-tubes were used, (3) in cases with repeated insertions of tubes, (4) with intubation exceeding 12 months, and (5) in cases with frequent postoperative otorrhea. Conclusions Cholesteatoma formation associated with VT placement occurs in 1.1% of the ears that are operated on, and therefore it should be discussed with patients or parents prior to surgery. Periodic and long-term follow-up microscopic examinations of the eardrum should be performed in all patients following tubal extrusion or removal, especially in those at high risk for developing a secondary cholesteatoma, to detect this complication as early as possible.

Background: Silver oxide-impregnated tympanostomy tubes have been shown to decrease the incidence of postoperative otorrhea, but without a significant effect in the first postoperative week. Objective: To evaluate prospectively our results with silver oxide-impregnated tympanostomy tubes and to identify factors associated with a higher incidence of early postoperative otorrhea. Design: Prospective nonrandomized study. Setting: University referral center. Patients and Other Participants: Six hundred thirty patients with chronic otitis media with effusion or recurrent otitis media. Interventions: Silver oxide-impregnated Silastic tympanostomy tubes were inserted in 1254 ears. Subjects with mucoid or purulent effusions or blood at the myringotomy site at surgery were treated with topical antibiotic prophylaxis (sulfacetamide sodium-prednisolone acetate or neomycin sulfate-polymyxin B sulfate-hydrocortisone) for 5 days after tympanostomy tube placement. Main Outcome Measures: Incidence of otorrhea after tympanostomy tube insertion at 1 week and 1,3,6,9, and 12 months after surgery. Results: The overall incidence of postoperative otorrhea was 1.9%. The incidence of otorrhea in the first postoperative week was 5.6%; the incidence of otorrhea after the first postoperative week was 1.2% (P

Objective To determine the efficacy of phenylephrine hydrochloride, a topical vasoconstrictor, in preventing tympanostomy tube obstruction. Design Prospective, randomized, double-blind, controlled trial of patients undergoing myringotomy with tympanostomy tube insertion. Setting Academic, tertiary referral medical center. Patients Two hundred eight patients were enrolled in the study; 157 patients (310 ears) returned for postoperative evaluation. Interventions Myringotomy with tympanostomy tube insertion was performed in all ears: 139 control ears received ototopical antibiotics and 171 treatment ears received ototopical antibiotics plus topical phenylephrine. Main Outcome Measure Postoperative tympanostomy tube obstruction. Results The overall incidence of tympanostomy tube obstruction was 5.2%: 8.6% in the control group and 2.3% in the treatment group. The treatment group demonstrated an odds ratio of 0.25 (95% confidence interval, 0.08-0.78; P =.02). Conclusion The use of phenylephrine following tympanostomy tube insertion greatly reduces the incidence of tube obstruction.

Objective To determine whether water exposure causes middle ear contamination in patients with collar button tympanostomy tubes (TTs). Method and Design An in vitro model of a human head that contained an auricle, external auditory canal, tympanic membrane with TT, middle ear, eustachian tube, and mastoid cavity was developed. Two electrodes connected to an external ohmmeter resided in the middle ear to detect water entry. The model was tested with 4 types of water exposure: showering, bathing, hair rinsing, and swimming. Statistical analysis was performed by the Fisher exact test. Main Outcome Measures A positive test result corresponded to water entering the middle ear via the TT, confirmed by a resistance reading of zero on the ohmmeter. A negative test result indicated no change in the initial high resistance reading. Results No positive test results were obtained for showering (0 of 60 tests), hair rinsing (0 of 60 tests), or head submersion (12.7 cm) in clean tap water (0 of 60 tests). Ten positive test results were obtained for head submersion in soapy water (10 of 97 tests), which was statistically different from clean water ( P ≤.007). Swimming pool depths of 30, 45, 60, and 75 cm elicited positive test results in 2 of 16, 3 of 18, 2 of 20, and 11 of 20 tests, respectively. A higher incidence of water entry into the middle ear occurred at depths of more than 60 cm ( P ≤.001). No statistical difference between depths of 60 cm or less occurred ( P =.88). Conclusions Showering, hair rinsing, and head submersion in clean tap water do not promote water entry into the middle ear. Submersion in soapy water increases the probability of water contamination. Pool water infrequently enters the middle ear with head submersion, but the incidence increases with deeper swimming (>60 cm). These data provide further evidence that many water precautions frequently advised in patients with TTs are unnecessary.

Objective To determine whether there is a relationship between the presumed complexity of auditory processing and the time course of recovery of auditory function in children with a history of otitis media with effusion (OME). Design Longitudinal testing over a 1-year period following insertion of tympanostomy tubes in clinical and control groups. Subjects A total of 34 children with a history of OME were tested. Twenty-five were tested both just before the placement of tympanostomy tubes and on up to 3 separate occasions (1 month, 6 months, and 1 year) after the placement of the tubes. With subject attrition, there were 27, 16, and 10 listeners at the 1-month, 6-month, and 1-year tests, respectively. An age-matched control group of 29 children was tested. Methods The comodulation masking release (CMR) paradigm was used to measure the ability of the listener to detect a signal in a noise background composed of a simple (1 amplitude modulation pattern) or more complex (2 amplitude modulation patterns) masking background. Results Children with a history of OME had reduced masking release before and 1 month after insertion of tympanostomy tubes for both the simple and complex CMR tasks. After surgery, the CMR results for simple task was not significantly different from that in controls by 6 months, but CMR for the complex task remained significantly reduced even 1 year after surgery. Conclusion Our results suggest a slower recovery of auditory function for more complex auditory tasks in children with a history of OME.

Background Postoperative complications of myringotomy and tube placement often include otorrhea, tympanosclerosis, and tympanic membrane perforation. However, the incidence of sensorineural or conductive hearing loss has not been documented. Recent efforts to curb the use of preoperative audiometric testing requires documentation of this incidence. Objective To define the incidence of conductive and sensorineural hearing loss associated with myringotomy and tube placement. Materials and Methods A retrospective chart review of 550 patients undergoing myringotomy and tube placement was performed. A total of 520 patients undergoing 602 procedures (1204 ears), including myringotomy and tube placement, were assessed for preoperative and postoperative sensorineural and conductive hearing loss. Results No patient developed a postoperative sensorineural or conductive hearing loss. All patients resolved their conductive hearing loss after myringotomy and tube placement. There was a 1.3% incidence of preexisting sensorineural hearing loss. Conclusions The incidence of sensorineural or conductive hearing loss after myringotomy and tube placement is negligible and the use of preoperative audiometric evaluation may be unnecessary in selected patients, but further studies need to be done to corroborate this small data set.

Objective To document the incidence of complications occurring secondary to placement of tympanostomy tubes in patients undergoing hyperbaric oxygen therapy. Design Retrospective chart review. Setting Tertiary referral center. Patients Forty-five patients referred to the Department of Otolaryngology for inability to tolerate hyperbaric oxygen therapy between January 1, 1990, and December 31, 1995. Interventions All patients underwent bilateral myringotomy and tube placement. Outcome Measures Charts were reviewed for complications of tube placement, including otorrhea, otalgia, hearing loss, persistent perforations, and tinnitus. Results Seventeen (38%) of 45 patients experienced complications, with most having more than 1. Most complications occurred after conclusion of hyperbaric oxygen therapy. Otorrhea was most common, occurring in 13 patients (29%). Persistent tympanic membrane perforations occurred in 7 patients (16%). Conclusions The rate of complications is higher than reported for placement of tympanostomy tubes in other patient populations. Coexisting illness, such as diabetes mellitus, may contribute to the development of complications in patients undergoing hyperbaric oxygen therapy. Alternative methods of tympanostomy, with emphasis on shorter duration of intubation, should be considered in this patient population.