© Borgis - New Medicine 2/2002, s. 71-72
Małgorzata Dębska, Anna Bielicka, Mieczysław Chmielik
Ventilating tube insertion in the treatment of otitis media with effusion in children
Department of Paediatric Otorhinolaryngology, The Medical University of Warsaw, Poland
Head: prof. Mieczysław Chmielik, M.D.
The authors present methods of surgical treatment of otitis media with effusion in children. The advantages and complications of ventilating tube insertion are given particullar attention.
A uniform scheme for treatment of otitis media with effusion in children is difficult, and it is not always possible due to the complicated aetiology and differing progression of this disease. The choice of treatment method depends on disease duration, degree of hearing loss, the appearance of the tympanic membrane in otoscopy, and the type and amount of residual secretion in the middle ear.
In laryngological literature there are different methods of treatment of otitis media with effusion, viz:
– medical treatment (anti-inflammatory drugs, antihistamines, anti-exudative drugs, nasal decongestants, mucolytic drugs),
– polterization, tubal insufflation by Valsalva´s method,
– biostimulating laser,
– Eustachian catheterization,
– immunotherapeutic treatment,
– restoration of an upper respiratory tract patency,
– tytmpanopunction or tympanostomy with a suction of residual secretion from the middle ear,
– permanent drainage of the tympanic cavity (ventilating tubes) (2).
In the event of middle ear effusion, the need to remove the inflammatory focus from the nose, nasopharynx, or paranasal sinuses should be considered. Conservative therapy of otitis media with effusion should not last longer than three months. After this period, surgical treatment should be performed. This treatment consists of the restoration of upper respiratory tract patency in patients with adenoids, nasal septum deviation, or nasal polyps. Simultaneously, tympanopunction with suction of any residual secretion from the middle ear may be performed, or may be performed as an independent surgical procedure. When allergic rhinitis coexists with otitis media with effusion, consultation with an allergologist, leading to antiallergic treatment, will be needed.
The most frequent cause of otitis media with effusion is adenoids, and therefore tympanostomy is usually performed alongside surgical procedures leading to restoration of patency of the auditory tube, such as adenoidectomy, adenotonsillotomy and, exceptionally, tonsillectomy.
Tympanostomy should be performed as a consequence of:
– short-lasting conductive hearing loss with a type B tympanometry curve,
– conductive hearing loss below 30-35 dB,
– presence of otoscopic changes characteristic of otitis media with effusion,
– type B tympanometry curve co-existing with sensorineural hearing loss (2).
If, in spite of surgical treatment, otitis media with effusion recurs, the next stage of treatment is the insertion of a ventilating tube. This allows reduction of pressure differences between the middle and exterior ear, and allows a decrease in secretion from the tympanic cavity and the mastoid process cells through the Eustachian tube. Normal ventilation of the middle ear by a ventilating tube allows permanent regression of pathological changes in the middle ear. Ventilating tube insertion should, however not be the first and only method of treatment of otitis media with effusion in children.
Ventilating tube placement is indicated in the following cases:
– conductive hearing loss lasting over 6 months,
– tympanic membrane atrophy, retraction pouches, or adhesions,
– thick mucous secretion in the middle ear,
– recurrent acute otitis media,
– facial skeletal abnormalities causing nasal obstruction and Eustachian tube dysfunction (2).
Powyżej zamieściliśmy fragment artykułu, do którego możesz uzyskać pełny dostęp.
Płatny dostęp tylko do jednego, POWYŻSZEGO artykułu w Czytelni Medycznej
(uzyskany kod musi być wprowadzony na stronie artykułu, do którego został wykupiony)
Płatny dostęp do wszystkich zasobów Czytelni Medycznej