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Background: This systematic review and meta-analysis aimed to investigate the current evidence on the efficacy of tympanostomy and adenoidectomy in children with otitis media with effusion in comparison with tympanostomy alone following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Materials and Methods: We completed a comprehensive search of PubMed, Web of Science, Scopus and Cochrane Library databases for relevant studies published in the literature with no date restrictions. We collected the results of the databases search and removed duplicated studies by Rayyan QCRI and EndNote Software X8. We used an Excel sheet for screening titles and abstracts, full text and data extraction. For quality assessment, we used Cochrane Handbook of Systematic Reviews of Interventions 5.1.0 using the quality assessment table provided in Part 2 and Chapter 8.5, and quantitative data synthesis was done using Review Manager (RevMan) software version 5.4. Results: The literature search showed 1510 studies, of which five studies were included in data synthesis. The study measured the effect through number of acute otitis media (AOM) episodes, cumulative number of AOM episodes, siblings with Otitis media (OM), hearing level hearing loss scale of the left, and right ears. The pooled effect estimates showed significant difference between tympanostomy with adenoidectomy versus tympanostomy alone in hearing level hearing loss scale of both ears (SMD -0.17, 95% CI [-0.29, -0.05], P-value=0.005). However, the pooled results were not heterogeneous (P < 0.25, I2 = 24%). Conclusions: Tympanostomy with adenoidectomy improves hearing compared to tympanostomy alone, but both treatments have similar effects on ear infection rates. Further research with larger samples is needed to confirm these findings and assess long-term benefits.

Otitis media results from a multitude of factors that cause inflammation of the lining of the tympanic cavity and/or structures of the middle ear, including infections, middle ear polyps, and neoplasms. Cats with otitis media can be asymptomatic or exhibit clinical signs of otitis externa, neurologic deficits, or upper respiratory tract disease. A therapeutic challenge is presented by cats' unique, almost complete, septum bulla in the ventral cavity of the middle ear. Diagnosis of otitis media relies on visualization of material in the middle ear by otoscopy or imaging. Treatment requires management of the underlying cause as well as removal of the material in the middle ear by minimally invasive (e.g., myringotomy and bulla lavage) or surgical (e.g., ventral bulla osteotomy) techniques. [ABSTRACT FROM AUTHOR]

Chronic tympanic membrane perforation represents a prevalent otological condition, necessitating a reliable animal model for the validation and safety assessment of surgical techniques and materials employed in myringoplasty. This prospective study involved the establishment of chronic tympanic membrane perforation animal models in 16 chinchillas. A thermic myringotomy was conducted on the right ear (study group), followed by cold instrument myringotomy, coupled with the topical application of mitomycin C and dexamethasone solution on the left ear (control group). Results revealed that tympanic membrane perforations in the study group persisted for a minimum of 4 weeks in 93.7% of cases and extended to 12 weeks in 62.5% of the cases. In contrast, all tympanic membrane perforations in the control group were present at 4 weeks, with only 37.5% persisting after 12 weeks, although statistical tests did not find significant differences between the two groups (chi-square: p-value = 0.157, Kruskal–Wallis: p-value = 0.093, Mann–Whitney: p-value = 0.121). The thermic myringotomy employed to induce chronic tympanic membrane perforation in animals demonstrated efficiency and sustainability. This model, characterized by stability and reproducibility, holds promise for future experimental applications in the field. [ABSTRACT FROM AUTHOR]

Abstract Objectives Phonological development is dependent on the integrity of the auditory system. Otitis media with effusion (OME) may affect speech perception in children and therefore phonological development. The aim of this study was to investigate the impact of persistent OME on the phonological performance of preschool children. Methods Sixty children with persistent OME who were candidates for myringotomy and ventilation tube insertion were included in this prospective observational study. We assessed their phonological skills before and after surgery (3 and 6 months) by phonological production tasks that included calculation of percentage of consonants correct (PCC) and process density index (PDI). Results We detected preoperative poor phonological performance in 91.7% of children. We found statistically significant differences in PCC and PDI between the three time periods. Also, there was a significant improvement after 6 months compared to 3 months. Conclusions OME has an adverse consequence on the phonological performance of preschool children, it can affect different domains such as PCC and PDI. The findings of this study revealed that myringotomy with ventilation tube insertion for children with persistent OME could aid in the development of intact phonological skills.

Background: Otitis media with effusion, a typical condition characterized by fluid in the middle ear area, has a significant negative influence on both the health and economy of the entire world. In children, hearing loss brought on by otitis media with effusion can hinder the development of language and conduct. This study aimed to assess how local dexamethasone affects human tympanic membranes' ability to resist myringosclerosis brought on by ventilation tubes. Patients and Methods: This prospective case-control study was conducted at Benha University Hospital, on 50 patients of both sexes and different ages complained of hearing loss due to persistent otitis media with effusion that has been resistant to therapy for nearly three months. The patients were subdivided into two equal groups: 25 patients were participants in group (A), which underwent myringotomy with breathing tube insertion only. 25 patients were participants in group (B), who had myringotomy, breathing tube insertion, and local dexamethasone instillation. Results: As far as myringosclerosis was concerned, there was no statistically significant variation between the two groups (P-value > 0.05). As determined by the quadrants under otomicroscopic examination, there was a significant variation between the two groups (P-value < 0.01) in relation to myringosclerosis findings. The histopathological assessment of myringosclerosis revealed a significant variation between the two groups with regard to the condition's symptoms (P-value < 0.01). Conclusion: Topical dexamethasone use may be helpful in avoiding the development of myringosclerosis. Dexamethasone's anti-inflammatory and immunosuppressive properties may be responsible for this impact. [ABSTRACT FROM AUTHOR]

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 [ABSTRACT FROM AUTHOR]

Objectives: Phonological development is dependent on the integrity of the auditory system. Otitis media with effusion (OME) may affect speech perception in children and therefore phonological development. The aim of this study was to investigate the impact of persistent OME on the phonological performance of preschool children. Methods: Sixty children with persistent OME who were candidates for myringotomy and ventilation tube insertion were included in this prospective observational study. We assessed their phonological skills before and after surgery (3 and 6 months) by phonological production tasks that included calculation of percentage of consonants correct (PCC) and process density index (PDI). Results: We detected preoperative poor phonological performance in 91.7% of children. We found statistically significant differences in PCC and PDI between the three time periods. Also, there was a significant improvement after 6 months compared to 3 months. Conclusions: OME has an adverse consequence on the phonological performance of preschool children, it can affect different domains such as PCC and PDI. The findings of this study revealed that myringotomy with ventilation tube insertion for children with persistent OME could aid in the development of intact phonological skills. [ABSTRACT FROM AUTHOR]

This article discusses the use of the expanded endonasal transpterygoid approach (EETA) in accessing 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. However, anterolateral transposition of the ET has been proposed as an alternative to decrease potential morbidity. This retrospective cohort study found that ET resection during EETA was significantly correlated with the need for myringotomy post-operatively. Patients should be counseled about this risk, while other factors such as radiation treatment, malignant pathology, and CPK class were associated with the need for myringotomy but did not reach significance in multivariate analysis. [Extracted from the article]

Inner ear involvement (IED) is a rare local complication of the very common acute otitis media (AOM). The most beneficial treatment for IED remains a matter of debate. The aim of this study is to analyze different treatment modalities based on hearing outcomes to contribute to the discussion of therapy for IED in AOM. This retrospective study includes 112 adult patients diagnosed with AOM with IED between 2000 and 2020. Patients either received conservative (systemic antibiotic and systemic steroid therapy), interventional (conservative plus myringotomy and tympanic tube) or operative (interventional plus antrotomy) treatment. Pre- and post-treatment pure tone audiometry was performed. The hearing outcome was compared, and hearing recovery was analyzed based on modified Siegel's criteria. The pre-treatment pure tone average (PTA) was significantly (p < 0.05) higher in the operative group than in the other groups. All treatment modalities led to a significant hearing improvement (p < 0.001). The pre- and post-treatment hearing loss was predominantly observed in high frequencies 2–4 kHz. The operative group showed the highest rate of complete hearing recovery. While all treatment modalities led to a significant improvement in hearing, the operative group showed the most beneficial hearing results in patients with high pre-treatment hearing loss. It remains to be shown if the findings in patients with high pre-treatment hearing loss can be generalized to patients with mild or moderate pre-treatment hearing loss. [ABSTRACT FROM AUTHOR]

A 46-year-old man who had been diagnosed with eosinophilic otitis media (EOM) and eosinophilic chronic rhinosinusitis was referred to our department. He suffered from bilateral earache, clogged ear sensation, and otorrhea associated with EOM. He had been treated with a myringotomy and a ventilation tube (VT) insertion. However, his symptoms did not improve, and the VT repeatedly fell out. We performed canal wall down mastoidectomy via a retro-auricular incision to remove the presumed cholesterol granuloma (CG) and a long-term VT insertion. The VT fell out repeatedly. Therefore, a large VT that Komune devised was inserted. Four months after reinsertion, there was no evidence of recurrent otorrhea or fallout of a large VT. A large VT insertion could be useful in the severe case of EOM with CG. [ABSTRACT FROM AUTHOR]

Background: To assess perioperative effect of oral ketorolac and acetaminophen in children undergoing bilateral myringotomy (BMT). Methods: Seventy five paediatric patients of ASA physical status I or II scheduled to undergo elective bilateral myringotomy (BMT) of both genders were divided into three groups of 25 each. Group I received saline (placebo), Group II acetaminophen (10 mg/kg) and Group III ketorolac (1 mg/kg). No other preanaesthetic medications were administered. Results: Group I had 15 males and 10 females, Group II had 12 males and 13 females and Group III had 11 males and 14 females. Duration of surgery was 8.4 minutes in Group I, 8.0 minutes in Group II and 7.4 minutes in group III. Duration of anaesthesia was 14.7 minutes in Group I, 14.3 minutes in Group II and 13.9 minutes in Group III. Oxygen saturation on arrival in PACU was 96.4% in Group I, 96.3% in Group II and 96.1% in Group III. The difference was significant (P< 0.05). The mean eye opening (mins) was 11, 13 and 14, response to commands (mins) was 14, 20 and 21, first oral intake (mins) was 31.5, 29.4 and 30.2, ambulation (mins) was 52.3, 75.4 and 54.0, discharge home (mins) was 72.6, 77.8 and 78.5, behaviour score in PACU before meeting parent(mins) was 2.3, 2.2 and 1.3, after meeting parent (mins) was 1.2, 1.1 and 1.0 and postoperative emesis was 13%, 15% and 22%. A non- significant difference was observed (P> 0.05). Conclusion: Both oral ketorolac and acetaminophen are safe and effective analgesics for perioperative pain management in children undergoing bilateral myringotomy. They can be used alone or in combination with other analgesics to provide multimodal pain management. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract 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

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Otitis media (presumably caused by Mycoplasma bovis) is a frequently encountered problem with big economic implications in the Dutch veal calf industry. Conservative treatment using antibiotics, NSAIDs and corticosteroids is regularly unsuccessful. The affected calves usually start to waste due to pain and decreased feed intake. This report describes a novel treatment option, performing a myringotomy (surgical opening of the eardrum), combined with local antibiotic and corticosteroid therapy. The outcome was positive; in four out of five calves, the clinical signs resolved within 3 weeks after intervention. On‐farm myringotomy is a promising treatment option in persistent otitis media. [ABSTRACT FROM AUTHOR]

Introduction. In the first part of the paper, the authors propose to systematize the data from the literature on seromucous otitis. Material and methods. We performed a retrospective clinical study, starting from the premise that there are 3 therapeutic trends for children with chronic seromucous otitis in medical practice. A first group includes children who only underwent adenoidectomy, the second who underwent adenoidectomy and myringotomy and the third group who underwent adenoidectomy and the installation of a trans- tympanic drainage tube. The results were compared, and a new therapeutic protocol regarding the pediatric patients with chronic seromucous otitis comes as a final conclusion.

To evaluate the intraoperative findings and post-operative complications associated with patients who have current or history of myringotomy tubes undergoing a cochlear implantation. 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. 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). 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of tympanometry for diagnosing fluid in the middle ears of children with Otitis Media with Effusion taking myringotomy as a gold standard. Study Design: Cross-sectional study Place and Duration of Study: Department of ENT & Head and Neck Surgery, Combined Military Hospital, Peshawar Pakistan, from Oct 2018 to Sep 2020. Methodology: A total of 201 patients who underwent tympanometry followed by myringotomy of aged between 3 to 12 years of either gender were included. All patients underwent tympanometry. After that, myringotomy was carried out through a radial incision in the anteroinferior quadrant using a general inhalational anaesthetic agent. The operative findings at myringotomy were recorded. The presence of fluid on intraoperative findings using myringotomy was considered positive for the presence of fluid in the middle ears of children. Results: The age range of the patients was from 3-12 years, with a mean age of 7.35±2.41 years. Of these 207 patients, 133(64.18%) were males, and 74(35.82%) were females. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of tympanometry for diagnosis of fluid in the middle ears of children with Otitis Media with Effusion taking myringotomy as the gold standard was 85.7%, 86.3%, 89.4%, 81.7% and 85.9% respectively. Conclusion: This study concluded that the diagnostic accuracy of tympanometry for the diagnosis of fluid in the middle ears of children with Otitis Media with Effusion is quite high. [ABSTRACT FROM AUTHOR]

Introduction. In the first part of the paper, the authors propose to systematize the data from the literature on seromucous otitis. Material and methods. We performed a retrospective clinical study, starting from the premise that there are 3 therapeutic trends for children with chronic seromucous otitis in medical practice. A first group includes children who only underwent adenoidectomy, the second who underwent adenoidectomy and myringotomy and the third group who underwent adenoidectomy and the installation of a trans- tympanic drainage tube. The results were compared, and a new therapeutic protocol regarding the pediatric patients with chronic seromucous otitis comes as a final conclusion. [ABSTRACT FROM AUTHOR]

Background: Due to the short duration of effect, simple myringotomy and aspiration of fluid do not yield significant therapeutic outcomes. Objective: To compare the efficacy of myringotomy with intratympanic dexamethasone injection versus grommet tube insertion in treatment of Otitis Media with effusion (OME). Subjects and Methods: At Oto-Rhino-Laryngology, Department of Zagazig University Hospital, during the period from 2021 to 2022 on 13 patients (26 ears) with persistent OME. Ears were divided into two groups: Group (A) included right ears that underwent the radial grommet tube. Group (B) included left ears that underwent the circumfrential myringotomy with intratympanic dexamethasone Results: There was statistically no significant difference as regards tympanosclerosis and persistent discharge between both right and left ears. At right ears, 15.4% of cases showed both persistent discharge and tympanosclerosis while 38.5% of left ears showed tympanosclerosis and no residual discharge. There was a statistically significant difference in the rate of recurrence between the right and left ears 6 months after surgery, with 23.1% of left ears reporting recurrence while 100% of right ears showed no recurrence. Conclusion: Myringotomy with grommet tube insertion with or without adenoidectomy is a classical method in treatment of chronic OME with potential complications especially otorrhea with less significant low recurrence rate. On other hand, circumferential myringotomy with ITD an effective method in treatment of chronic OME with less postoperative complications -equivalent postoperative hearing threshold, but with higher recurrence rate. [ABSTRACT FROM AUTHOR]

Myringotomy with grommet insertion is considered the standard of care for patients with unresolved otitis media with effusion and is traditionally performed under the operating microscope. The introduction of endoscopic ear surgery has provided otologists a tool for minimally invasive ear surgery with a panoramic view. We have described the use of endoscope for myringotomy and grommet insertion. The technique was found to be safe and effective and has the added advantage of being an excellent tool for teaching. The advantages and disadvantages of this technique vis a vis the traditional otomicroscopic technique have been discussed. [ABSTRACT FROM AUTHOR]

Otitis media with effusion (OME) is the most common cause of acquired pediatric hearing loss. The treatment of persistent OME includes myringotomy with or without tube insertion, with a reported recurrence rate of 19.9–40%. This study aims to investigate the recurrence rate of OME and its predictors following myringotomy. A retrospective study that included 345 ears that underwent myringotomy for persistent OME in 179 pediatric patients during 2016–2018. Patients were followed for 36–48 months post myringotomy procedure to detect the recurrence rate. The study sample was divided into two groups based on recurrence status, and the groups were compared using chi-square test and independent T-test. Significant variables (p-value ≤ 0.05) were included in the logistic regression model to determine the predictors of OME recurrence after myringotomy. OME recurrence was detected in 85 ears (24.64%). The OME recurrence rate is higher in patients who underwent myringotomy alone compared to myringotomy with tube insertion (44.1% vs. 22.8%). The insertion of a tympanostomy tube decreases the recurrence rate of OME by 59.9% (OR 0.401; 95% CI 0.162–0.933). The other socio-demographic and clinical characteristics such as age, siblings, daycare attendance, passive smoking, previous acute otitis media, atopy, and adenoidectomy did not significantly influence OME recurrence (p-value > 0.05). The recurrence rate of OME following myringotomy is high. Myringotomy with tube insertion significantly decreases the recurrence rate and the need for further surgeries compared to myringotomy alone. Adenoidectomy and the patient's age have no impact on the recurrence rate of OME. [ABSTRACT FROM AUTHOR]

Objective: Lengthy wait times for elective surgery is a widespread health care system conundrum that may increase patient distress and jeopardize health outcomes. The primary aim of this quality improvement project was to reduce the surgical wait time in patients undergoing tympanostomy tube insertion. Methods: As of January 2018, our tertiary care institution implemented a novel protocol whereby healthy children may undergo tympanostomy tube insertion in a minor procedure room under ketamine sedation administered by pediatric emergency physicians to address lack of both physical and anesthesia staffing resources. A retrospective study of all children undergoing elective tympanostomy tube insertion was conducted between September 1, 2017, and May 8, 2019, to assess wait time to surgery, as well as anesthesia-related and surgical complications. Results: Procedural sedation in minor procedure rooms effectively decreased surgical wait times by 53 days (from 134 to 81 days, P <.001) at 16 months postimplementation. This new protocol was found to be safe and effective for healthy children, with no major surgical or anesthesia-related complications noted in 113 patients having undergone the procedure in the novel setting. Discussion: Although conscious sedation by emergency physicians has been well studied across a variety of surgical procedures, its novel use in pediatric tympanostomy tube insertion requires careful patient selection to enhance accessibility while maintaining anesthetic safety. Implications for Practice: This quality improvement project describes a novel combination of processes, using a minor procedure room space and ketamine-based procedural sedation to address surgical wait times in pediatric patients undergoing tympanostomy tube insertion. [ABSTRACT FROM AUTHOR]

Abstract Objective Pneumococcal conjugate vaccines (PCVs) have been reported to reduce the incidence of myringotomy with tympanostomy tube insertion (MTTI) in children. However, little information is available focusing specific ages. We examined the prophylactic efficacy of PCVs on the onset of complex otitis media (ComOM) that requires MTTI. Method From 2011, the public support for PCV7 started with the usual four‐dose schedule and an emergency schedule for 2‐ to 4‐year‐old children in Japan. PCV7 was replaced with PCV13 in 2013. We reviewed the nationwide database obtained from the JMDC Claims Database (https://www.jmdc.co.jp/en/) to examine the MTTI incidence during the era before and after PCV introduction (from 2008 to 2010 and from 2011 to 2017, respectively). Subjects were analyzed by stratified age groups (from 0 to 8 years old) and in subdivided groups of 6 months (from 0 to 35 months old). We compared the MTTI incidence between the groups for each age as well as between those for each calendar year. Results A significant reduction in the MTTI incidence was detected in the 1‐year‐old children of the PCV era compared to those of the pre‐PCV era. The reduction rates were more prominent in the 12–17 months group as compared to the 18–23 months group (PCV7 p = .005 and PCV13 p = .011, PCV7 p = .014 and PCV13 p = .153, respectively). The significant difference in the 1‐year‐old children continued in six of seven calendar years from 2011 to 2017, whereas no significant reduction was detected in children >3 years old. Conclusions The introduction of both PCV7 and PCV13 reduced MTTI incidences in children around 1 year old, and the effects were more prominent during the early half‐periods. Our results support etiological evidence that pneumococcal infection in children aged 1 year and younger might play roles in the pathogenesis of ComOM that requires MTTI.

Introduction: Grommet insertion is a common procedure in field of Otology. Its outcome depends highly on degree of experience of the surgeon.Simulation in training and clinical practice is an important facet in a surgeon’s life. However, the non-availability of fresh cadavers, pre-existing damaged tympanic membrane in available cadavers and escalating cost of artificial cadaveric materials led us to devise a simple yet effective way of training technique for grommet insertion, utilizing “stretched surgical glove piece over an ear speculum”.An observational study was undertaken in our department to assess utility of this technique in training ten trainees. They reported subjective improvement in manual dexterity during performing myringotomy as well as mounting, manipulating and inserting the grommet during actual surgery.Our innovation is cheap, reliable and readily available for training. It closely resembles real-time surgical experience.Materials and methods: Grommet insertion is a common procedure in field of Otology. Its outcome depends highly on degree of experience of the surgeon.Simulation in training and clinical practice is an important facet in a surgeon’s life. However, the non-availability of fresh cadavers, pre-existing damaged tympanic membrane in available cadavers and escalating cost of artificial cadaveric materials led us to devise a simple yet effective way of training technique for grommet insertion, utilizing “stretched surgical glove piece over an ear speculum”.An observational study was undertaken in our department to assess utility of this technique in training ten trainees. They reported subjective improvement in manual dexterity during performing myringotomy as well as mounting, manipulating and inserting the grommet during actual surgery.Our innovation is cheap, reliable and readily available for training. It closely resembles real-time surgical experience.Result: Grommet insertion is a common procedure in field of Otology. Its outcome depends highly on degree of experience of the surgeon.Simulation in training and clinical practice is an important facet in a surgeon’s life. However, the non-availability of fresh cadavers, pre-existing damaged tympanic membrane in available cadavers and escalating cost of artificial cadaveric materials led us to devise a simple yet effective way of training technique for grommet insertion, utilizing “stretched surgical glove piece over an ear speculum”.An observational study was undertaken in our department to assess utility of this technique in training ten trainees. They reported subjective improvement in manual dexterity during performing myringotomy as well as mounting, manipulating and inserting the grommet during actual surgery.Our innovation is cheap, reliable and readily available for training. It closely resembles real-time surgical experience.Conclusion: Grommet insertion is a common procedure in field of Otology. Its outcome depends highly on degree of experience of the surgeon.Simulation in training and clinical practice is an important facet in a surgeon’s life. However, the non-availability of fresh cadavers, pre-existing damaged tympanic membrane in available cadavers and escalating cost of artificial cadaveric materials led us to devise a simple yet effective way of training technique for grommet insertion, utilizing “stretched surgical glove piece over an ear speculum”.An observational study was undertaken in our department to assess utility of this technique in training ten trainees. They reported subjective improvement in manual dexterity during performing myringotomy as well as mounting, manipulating and inserting the grommet during actual surgery.Our innovation is cheap, reliable and readily available for training. It closely resembles real-time surgical experience. [ABSTRACT FROM AUTHOR]

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.

Background: Otitis media with effusion is a collection of fluid inside the middle ear cleft, treatment of this condition include medical and surgical methods. This research goal is to focus and specify the clinical features of OME and the association between the new staging and the postoperative findings after surgery of insertion of ventilation tubes (VTs). Objectives: The objective of the study was to assess postoperative sequelae after VT insertion in children. Patients and Methods: Thirty two children with OME with surgical insertion of short term ventilation tubes were included in this study and followed up for one year. Results: In 22 patients, the fluid aspirated surgically after myringotomy was serous, whereas 10 patients were mucinous; for the patients, 53.12% had recurrence, whereas 46.88% showed no recurrence of OME. Only 6.25% of cases included in this study developed myringosclerosis; no otorrhea was reported during the period of the presence of VT in the tympanic membrane, no persistent tympanic membrane perforation after VT auto‑extrusion. Conclusion: Even though VT have shown to be very useful in solving conductive hearing loss, its efficacy is a matter of debate in preventing long‑term poor effects of the tympanic membrane and delayed onset of hearing loss. Even though ventilation tubes have shown to be very useful in solving the problem of conductive hearing loss. [ABSTRACT FROM AUTHOR]

Background: Secretory otitis media is chronic inflammation of middle ear cleft characterized by accumulation of nonpurulent fluid behind intact tympanic membrane. This study was done to identify various modes of presentation of secretory otitis media in different age groups and gender and to evaluate its outcome by various modalities of treatment. Material And Methods: This study comprised of 50 cases of bilateral or unilateral secretory otitis media of all the age groups. It is prospective observational study. Secretory otitis media is diagnosed by history, otoscopic examination and audiometric evaluation. Complete history and examination was done according to the proforma. All the patients were given conservative and medical treatment and followed up regularly. Cases refractory to medical treatment required surgical treatment based on clinical presentation and associated symptoms. It was carried out during the period of August 2021 to April 2022, in ENT department of Sir T. general hospital Bhavnagar. Result: In this study, maximum number (28%) of cases belonged to age group of 10-20 years, more commonly seen in males with Male: Female ratio of 1.78:1.Most of the cases (44%) were from lower socioeconomic class. Ear blockage or fullness of the ear (76%) was the most common clinical presentation. On otoscopy, fluid level with air bubbles was seen most commonly (84%). All the cases (100%) were put on medical treatment and regularly followed up. 50% responded well but the remaining 50% refractory cases required other surgical modalities of treatment based on clinical presentation and associated symptoms. Surgical treatment included adenoidectomy and adenotonsillectomy (20%), myringotomy with grommet insertion (4%). Myringotomy was done in 20% of cases. Septoplasty was done in 6% of the patients of secretory otitis media. Conclusion: Secretory otitis media was common in 10-20 years age group. More common in males with lower socioeconomic class. Most common clinical presentation was ear blockage or fullness of ear. On otoscopy, fluid level with air bubbles was the most common sign. Treatment consisted of medical and surgical modalities. All the cases obtained subjective relief and improvement in the symptoms. [ABSTRACT FROM AUTHOR]

Case Presentation: A 15-year-old boy presented with three acute episodes of self-limited hemoptysis. He was being followed by the pediatric pulmonology department for necrotizing pneumonia and a right upper lobe lung abscess with residual pneumatocele 5 years earlier. He had also experienced recurrent perianal abscesses and more than 15 acute suppurative otitis media throughout his life, even after myringotomy and transtympanic drainage; methicillin-sensitive Staphyloccocus aureus was found in a culture of otic exudate. He had no known allergies and was not taking any drugs. The patient's father had presented with more than 20 skin abscesses and was carrier of methicillin-resistant S aureus. After necrotizing pneumonia and along with his family history, the patient had undergone a neutrophil oxidative burst test excluding chronic granulomatous disease; immunoglobulin levels and lymphocyte populations were within normal range. [ABSTRACT FROM AUTHOR]

Objective: Researchers aimed to design surgical simulation models using medical image processing and 3D-printing technologies to train otolaryngologie residents with correct surgical techniques and study their skills improvement. Materials and Methods: The models were produced for three age ranges (group A: 8-12 years old, group B: 3-7 years old, and group C: 10 months - 2 years old). Eleven residents were practiced from older to younger child models. Overall surgical time and results were evaluated to determine improvement. Both residents and specialists assessed satisfaction surveys after training. Results: The median operational time was significantly reduced by 64.57% in model A and 50.24% in model B (p < 0.05). Operating time and surgical skills improved in order from models A, B, and C. Model C showed the most improvement with correct operational techniques in myringotomy incision (66.7%, p = 0.003) and tympanostomy tube insertion (48.5%, p = 0.011). Residents’ and specialists’ satisfaction assessments exhibited prominent satisfaction results with surgical simulation model training. Conclusion: Surgical simulation models training enhanced residencies’ confidence and improved correct surgical techniques. Residencies can gradually practice skills from fundamental to more complicated techniques in younger child model where symptom occurs. [ABSTRACT FROM AUTHOR]

The study puts forth the learning curve of two handed endoscopic middle ear dissection on a sheep temporal bone. It also highlights the usage of sheep temporal bone as an effective simulation technique for two-handed cadaveric temporal bone dissection. 6 sheep temporal bone models were dissected in a period of 15 days. Harvesting of cartilage graft, endoscopic myringotomy and grommet insertion, cartilage butterfly tympanoplasty, ossiculoplasty, stapes surgery and facial nerve decompression, using the Endohold®, were conducted on each bone. There was a remarkable decrease in the time required for subsequent temporal bone dissections, with significant improvement in efficiency, accuracy and neatness of dissection. Practice and experience resulted in upliftment in the level of confidence of the fellow. Striking similarities were noticed between sheep and human temporal bones. Availability of both the hands with a clear endoscopic view made it easier and more convenient to perform various procedures. Two handed endoscopic technique provides an excellent approach for ear surgeries. Availability of both the hands for the delicate surgery along with the spectacular endoscopic view contributes to increase in efficiency and surgery outcome. Cadaveric dissection of sheep temporal bones provides a great learning experience for a trainee to practice these delicate and skilful two-handed endoscopic middle ear surgical exercises. Its easy availability and striking similarity of the anatomy makes it a boon for the beginners. It gives ample opportunity to the trainee to explore and learn the complex anatomy, try new skills and develop an expertise in this field. The efficiency and accuracy increases significantly with each dissection, smoothening out the steep learning curve, that is, for such fine and intricate surgical skills. [ABSTRACT FROM AUTHOR]

Introduction/Objective: Historically, myringotomy, and the insertion of tympanostomy tubes has served as one of the initial surgical training experiences for residents. Resident experience with this procedure since the introduction of pneumococcal conjugate vaccines has not been well described in the literature. The objective of this study was to identify trends in resident training experience with chronic otitis media-related surgeries, such as myringotomy and tympanostomy tube placement. While multiple factors influence resident experience, we hypothesize that resident experience has decreased since the introduction of the pneumococcal 13-valent conjugate vaccine (PCV13). Methods and Materials: In a retrospective review of Accreditation Council for Graduate Medical Education (ACGME) National Data Reports, mean number of myringotomy and tympanostomy tube cases logged in the Resident Case Log System from 2006 to 2019 were collated and plotted against years to identify monotonic trends. Mann-Whitney U test was used to compare pre-PCV13 era and post-PCV13 era data. Results: Since the introduction of PCV13, there is a national decreasing trend in the myringotomy and tympanostomy tube placement by otolaryngology residents (P =.001). Conclusions: Otologic surgeries are an important part of resident education and historically have served as one of the initial surgical training experiences for residents. There has been a significant reduction in the number of myringotomy and tympanostomy procedures performed by otolaryngology residents in the past decade. While multiple factors influence resident experience, it is possible that introduction of PCV13 has impacted resident exposure to myringotomy and tympanostomy tube placement. Resident proficiency with this procedure has likely not been affected by introduction of PCV13. Data should be reassessed in 5 years to determine if an impact of the PCV13 vaccine on resident training is evident. [ABSTRACT FROM AUTHOR]

Case Series Summary: The efficacy of medical treatment associated with single myringotomy in cats with suppurative otitis media (OM) and intact tympanum was retrospectively evaluated. Patients' records were retrieved from cats with suppurative OM. Cats were included in this retrospective study based on fluid content within the tympanic cavity on imaging, intact tympanum on otoendoscopic examination and neutrophils on ear bulla exudate cytological examination. A total of 26 cats with middle ear suppurative otitis were included. Just over half of the cats (54%) presented bilateral involvement. Clinical signs included head tilt (13/26), otalgia (9/26), Horner's syndrome (7/26), external ear discharge (5/26), and nystagmus and facial paralysis (1/26). Cocci were identified on cytological examination in 18/40 samples and rods in 2/40. Bacterial culture results were positive in 15/40 samples, with Pseudomonas species (4/15), Pasteurella multocida (3/15), Staphylococcus felis (3/15), Staphylococcus schleiferi (2/15), Staphylococcus canis (2/15), Escherichia coli (2/15), Staphylococcus pseudintermedius (1/15) and Serratia marcesens (1/15) isolation. After myringotomy and gentle flushing of middle ear bullae (0.5-2 ml saline per ear), all cats were treated with oral corticosteroids and a 1-month course of systemic antibiotics according to sensitivity testing. In total, 19 (73%) cats were clinically healed 60-240 days after treatment. One cat was euthanased because of failure to eradicate a Pseudomonas species infection. Another cat died a few hours after the procedure. The five remaining cats were cured after ventral bulla osteotomy., Relevance and Novel Information: OM without an aural polyp is a frequent diagnosis in cats, but data on medical treatment are scarce. This simple therapeutic technique, single myringotomy procedure and mild ear flushing, offers a practical, safe and efficient first-line treatment of suppurative OM with an intact tympanum in cats with or without neurological signs., Competing Interests: Conflict of interestThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Researchers aimed to design surgical simulation models using medical image processing and 3D-printing technologies to train otolaryngologie residents with correct surgical techniques and study their skills improvement. Materials and Methods: The models were produced for three age ranges (group A: 8-12 years old, group B: 3-7 years old, and group C: 10 months - 2 years old). Eleven residents were practiced from older to younger child models. Overall surgical time and results were evaluated to determine improvement. Both residents and specialists assessed satisfaction surveys after training. Results: The median operational time was significantly reduced by 64.57% in model A and 50.24% in model B (p < 0.05). Operating time and surgical skills improved in order from models A, B, and C. Model C showed the most improvement with correct operational techniques in myringotomy incision (66.7%, p = 0.003) and tympanostomy tube insertion (48.5%, p = 0.011). Residents’ and specialists’ satisfaction assessments exhibited prominent satisfaction results with surgical simulation model training. Conclusion: Surgical simulation models training enhanced residencies’ confidence and improved correct surgical techniques. Residencies can gradually practice skills from fundamental to more complicated techniques in younger child model where symptom occurs.

Primary Secretory Otitis Media in the Cavalier King Charles Spaniel is a rare and complex disorder. However, using a well established protocol, including well established procedures, modern day imaging technology, precise treatment and adequate post-treatment care can lead to a high rate of successfully dissipated symptoms and long-term well-being our the patients. The suggested protocol is based on 14 examined patients in a 1 year time period. It includes otoscopic examination, cytology, culture and sensitivity testing, magnetic resonance imaging, viodeootoscopy, deep ear cleaning, myringotomy, educating the owners, owners' feedback, subsequent therapy and long-term follow up. The study concludes that MRI and educating the owners are two extremely important tools that should not be overlooked. Additionally, further research with the addition of DNA analysis is needed. [ABSTRACT FROM AUTHOR]

Orbital compartment syndrome (OCS) is an emergency that complicates intra-orbital, retrobulbar hemorrhage in most cases. Bony orbital decompression is an effective treatment for OCS, and displaced orbital fractures are protective. Nevertheless, in rare cases, OCS occurs despite a displaced orbital fracture. The aim of the current review is to present its pathophysiology and management based on what is published in the medical literature, and our center's experience. A systematic review of literature was conducted through PubMed, Medline, Embase, and Cochrane from inception through February 2021. The following search query was used: "orbital fracture" and "trauma" and "orbital compartment syndrome." Studies tackling the pathophysiology and management of concurrent displaced orbital fracture with OCS were included and a cohort of patients was constituted. A cohort of 18 cases reported in the literature were included (49.3 ± 30.6 years, 50% M). Given that OCS occurs with or without orbital fracture, pathophysiology of OCS is mostly explained by the division of the orbital fat into many compartments, due to the presence of Koorneef's fibrous septa. Management of OCS in such circumstances consisted of inferior-lateral canthotomy and cantholysis in 50% of cases, subperiosteal drainage with myringotomy in 22.2% of cases, subperiosteal drainage in 16.7% of cases, and complete lateral cantholysis in 16.7% of cases. Two cases who presented to our tertiary care center were also added to this review. Physicians should be aware that OCS can occur even with displaced fractures of the orbital cavity. When clinical suspicion is present, an emergent management is needed. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate behavioral strategies to minimize procedural distress associated with in-office tympanostomy tube placement for children without general anesthesia, sedation, or papoose-board restraints. 120 6-month- to 4-year-olds and 102 5- to 12-year-olds were treated at 16 otolaryngology practices. Mean age of children was 4.7 years old (SD = 3.18 years), with more boys (58.1%) than girls (41.9%). The cohort included 14% Hispanic or Latinx, 84.2% White, 12.6% Black, 1.8% Asian and 4.1% 'Other' race and ethnicity classifications. The in-office tube placement procedure included local anesthesia via lidocaine/epinephrine iontophoresis and tube placement using an integrated and automated myringotomy and tube delivery system. Behavioral strategies were used to minimize procedural distress. Anxiolytics, sedation, or papoose board were not used. Pain was measured via the faces pain scale-revised (FPS-R) self-reported by the children ages 5 through 12 years. Independent coders supervised by a psychologist completed the face, legs, activity, cry, consolability (FLACC) behavior observational rating scale to quantify children's distress. Mean FPS-R score for tube placement was 3.30, in the "mild' pain range, and decreased to 1.69 at 5-min post-procedure. Mean tube placement FLACC score was 4.0 (out of a maximum score of 10) for children ages 6 months to 4 years and was 0.4 for children age 5–12 years. Mean FLACC score 3-min post-tube placement was 1.3 for children ages 6 months to 4 years and was 0.2 for children age 5–12 years. FLACC scores were inversely correlated with age, with older children displaying lower distress. The iontophoresis, tube delivery system and behavioral program were associated with generally low behavioral distress. These data suggest that pediatric tympanostomy and tube placement can be achieved in the outpatient setting without anxiolytics, sedatives, or mechanical restraints. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Investigate an association between upper airway obstruction (UAO) management in Robin Sequence (RS) and need for bilateral myringotomy and tubes (BMT). Retrospective chart review of RS patients treated at a tertiary free-standing pediatric hospital from 1995 to 2020 was performed. Patients were grouped based on airway management: conservative, tracheostomy, tongue-lip adhesion (TLA), and mandibular distraction osteogenesis (MDO). Demographic data, cleft palate (CP) association, numbers of BMT and ear infections, and audiogram data including tympanograms were collected. One-way ANOVA and Chi-square/Fisher's exact tests were used to compare continuous and categorical data, respectively. Multivariable regression analysis was used to compare BMT rates between treatment groups. One hundred forty-eight patients were included, 70.3 % of which had CP. Most patients (67.6 %) had at least one BMT; 29.1 % required two or more BMT. The rate of BMT was higher in patients with CP compared to those with intact palates (p = 0.003; 95 % CI 1.30–3.57) and those treated with tracheostomy (p = 0.043; 95 % CI 1.01, 2.27). Surgically managed patients were more likely to have hearing loss (67.5 % vs. 35.3 %, p = 0.017) and ear infections (42.1 % vs. 20.0 %, p = 0.014) pre-compared to post-procedure for airway management. Most RS patients require at least 1 set of BMT. Those with CP and/or treated with tracheostomy had a higher likelihood of needing BMT. Rate of hearing loss and ear infection was higher in surgically managed RS patients. Patients with RS and overt CP require a statistically higher number of BMTs compared to those with either submucous cleft palate or intact palate. [ABSTRACT FROM AUTHOR]

The knowledge gap between practical research and its implementation in veterinary practice is becoming harder to bridge, as researchers now have a plethora of journals in which to publish. This paper summarizes recent research from the latest publications related to ear disease in dogs which have implications for veterinary practitioners. The topics reviewed include 16s rRNA new-generation sequencing, the use of oclacitinib in pinnal ulceration, the etiopathogenesis of aural hematoma, contamination of the middle ear during elective myringotomy and how to avoid it, and the use of carbon dioxide lasers in chronic obstructive otitis. [ABSTRACT FROM AUTHOR]

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Objective: Pneumococcal conjugate vaccines (PCVs) have been reported to reduce the incidence of myringotomy with tympanostomy tube insertion (MTTI) in children. However, little information is available focusing specific ages. We examined the prophylactic efficacy of PCVs on the onset of complex otitis media (ComOM) that requires MTTI. Method: From 2011, the public support for PCV7 started with the usual four‐dose schedule and an emergency schedule for 2‐ to 4‐year‐old children in Japan. PCV7 was replaced with PCV13 in 2013. We reviewed the nationwide database obtained from the JMDC Claims Database (https://www.jmdc.co.jp/en/) to examine the MTTI incidence during the era before and after PCV introduction (from 2008 to 2010 and from 2011 to 2017, respectively). Subjects were analyzed by stratified age groups (from 0 to 8 years old) and in subdivided groups of 6 months (from 0 to 35 months old). We compared the MTTI incidence between the groups for each age as well as between those for each calendar year. Results: A significant reduction in the MTTI incidence was detected in the 1‐year‐old children of the PCV era compared to those of the pre‐PCV era. The reduction rates were more prominent in the 12–17 months group as compared to the 18–23 months group (PCV7 p =.005 and PCV13 p =.011, PCV7 p =.014 and PCV13 p =.153, respectively). The significant difference in the 1‐year‐old children continued in six of seven calendar years from 2011 to 2017, whereas no significant reduction was detected in children >3 years old. Conclusions: The introduction of both PCV7 and PCV13 reduced MTTI incidences in children around 1 year old, and the effects were more prominent during the early half‐periods. Our results support etiological evidence that pneumococcal infection in children aged 1 year and younger might play roles in the pathogenesis of ComOM that requires MTTI. [ABSTRACT FROM AUTHOR]