Objective. The aim of this review was to study the effectiveness of ventilation tube (VT) treatment in children with secretory otitis media (SOM), assessed by improved hearing, normalized language and quality of life (QoL), and recurrent acute otitis media (rAOM), assessed by number of episodes of AOM and QoL.
Data Sources. Cochrane Library, PubMed, and Embase databases were searched for randomized and nonrandomized controlled trials and cohort studies in English, Scandinavian, German, and French languages between 1966 and April 2007. Additional literature was retrieved from reference lists in the articles.
Review Methods. A total of 493 abstracts were evaluated independently by 2 members of the project group, 247 full-text versions were assessed for inclusion criteria and quality using structured evaluation forms, and 63 articles were included in the review.
Results and Conclusions. This review shows that there is strong scientific evidence (grade 1) that VT treatment of SOM improves hearing for at least 9 months and that QoL is improved for up to 9 months (grade 2 scientific evidence). There was insufficient evidence to support an effect of VT treatment for rAOM. There was also insufficient evidence to determine whether the design or material of the VT or the procedure used for insertion had any influence on the effect; however, there was some evidence (grade 3) that aspiration of secretion at insertion does not prolong VT treatment. Further research is needed to address these issues.
ArmstrongBW. A new treatment for chronic secretory otitis media. Arch Otolaryngol. 1954;59:653-654.
2.
SchilderA. International perspectives on management of acute otitis media: a qualitative review. Int J Pediatr Otorhinolaryngol. 2004;68(1):29-36.
3.
Behandling av akut öroninflammation, konsensusuttalande [Consensus of treatment of otitis media; no English summary]. Stockholm: Swedish Medical Research Council; 2000.
4.
RoversMMStraatmanHIngelsK. The effect of ventilation tubes on language development in infants with otitis media with effusion: a randomized trial. Pediatrics. 2000;106:E42.
5.
RoversMMStraatmanHIngelsK. The effect of short-term ventilation tubes versus watchful waiting on hearing in young children with persistent otitis media with effusion: a randomized trial. Ear Hear. 2001;22:191-199.
6.
ParadiseJLFeldmanHMCampbellTF. Early versus delayed insertion of tympanostomy tubes for persistent otitis media: developmental outcomes at the age of three years in relation to prerandomization illness patterns and hearing levels. Pediatr Infect Dis J. 2003;22:309-314.
7.
MawRWilksJHarveyI. Early surgery compared with watchful waiting for glue ear and effect on language development in preschool children: a randomised trial. Lancet. 1999;353:960-963.
8.
MawARHerodF. Otoscopic, impedance, and audiometric findings in glue ear treated by adenoidectomy and tonsillectomy: a prospective randomised study. Lancet. 1986;1:1399-1402.
9.
MawARBawdenR. The long term outcome of secretory otitis media in children and the effects of surgical treatment: a ten year study. Acta Otorhinolaryngol Belg. 1994;48:317-324.
10.
DempsterJHBrowningGGGatehouseSG. A randomized study of the surgical management of children with persistent otitis media with effusion associated with a hearing impairment. J Laryngol Otol. 1993;107:284-289.
11.
GatesGAAveryCACooperJCJr. Chronic secretory otitis media: effects of surgical management. Ann Otol Rhinol Laryngol Suppl. 1989;138:2-32.
12.
LousJBurtonMJFeldingJUOvesenTRoversMMWilliamsonI. Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev. 2005;(1):CD001801.
13.
ParadiseJLFeldmanHMCampellTF. Early versus delayed insertion of tympanostomy tubes for persistent otitis media: developmental outcomes at the age of three years in relation to prerandomization illness patterns and hearing levels. Pediatr Infect Dis J. 2003;22:309-314.
14.
WilksJMawRPetersTJ. Randomised controlled trial of early surgery versus watchful waiting for glue ear: the effect on behavioural problems in pre-school children. Clin Otolaryngol Allied Sci. 2000;25:209-214.
15.
RosenfeldRMBhayaMHBowerCM. Impact of tympanostomy tubes on child quality of life. Arch Otolaryngol Head Neck Surg. 2000;126:585-592.
16.
TimmermanAAAnteunisLJMeestersCM. Response-shift bias and parent-reported quality of life in children with otitis media. Arch Otolaryngol Head Neck Surg. 2003;129:987-991.
17.
McGuireJRichmanN. Screening for behaviour problems in nurseries: the reliability and validity of the Preschool Behaviour Checklist. J Child Psychol Psychiatry. 1986;27:7-32.
18.
GebhartDE. Tympanostomy tubes in the otitis media prone child. Laryngoscope. 1981;91:849-866.
19.
LeCTFreemanDWFiremanBH. Evaluation of ventilating tubes and myringotomy in the treatment of recurrent or persistent otitis media. Pediatr Infect Dis J. 1991;10:2-11.
20.
CasselbrantMLKaleidaPHRocketteHE. Efficacy of antimicrobial prophylaxis and of tympanostomy tube insertion for prevention of recurrent acute otitis media: results of a randomized clinical trial. Pediatr Infect Dis J. 1992;11:278-286.
21.
RosenfeldRM. Surgical prevention of otitis media. Vaccine. 2000;19(suppl 1):134-139.
22.
RosenfeldRM. Clinical efficacy of medical therapy. In: Hamilton ed. Evidence Based Otitis Media. Hamilton, Ontario, Canada: BC Decker; 2003:199-226.
23.
GonzalezCArnoldJEWoodyEA. Prevention of recurrent acute otitis media: chemoprophylaxis versus tympanostomy tubes. Laryngoscope. 1986;96:1330-1334.
24.
Hammarén-MalmiSSaxenHTarkkanenJMattilaPS. Adenoidectomy does not significantly reduce the incidence of otitis media in conjunction with the insertion of tympanostomy tubes in children who are younger than 4 years: a randomized trial. Pediatrics. 2005;116:185-189.
25.
MattilaPSJoki-ErkkilaVPKilpiTJokinenJHervaEPuhakkaH. Prevention of otitis media by adenoidectomy in children younger than 2 years. Arch Otolaryngol Head Neck Surg. 2003;129:163-168.
26.
IinoYImamuraYHarigaiS. Efficacy of tympanostomy tube insertion for otitis media with effusion in children with Down syndrome. Int J Pediatr Otorhinolaryngol. 1999;49:143-149.
27.
SelikowitzM. Short-term efficacy of tympanostomy tubes for secretory otitis media in children with Down syndrome. Dev Med Child Neurol. 1993;35:511-515.
28.
MuntzHR. An overview of middle ear disease in cleft palate children. Facial Plast Surg. 1993;9:177-180.
29.
ValtonenHDietzAQvarnbergY. Long-term clinical, audiologic, and radiologic outcomes in palate cleft children treated with early tympanostomy for otitis media with effusion: a controlled prospective study. Laryngoscope. 2005;115:1512-1516.
30.
BroenPAMollerKTCarlstromJ. Comparison of the hearing histories of children with and without cleft palate. Cleft Palate Craniofac J. 1996;33:127-133.
31.
MasinJSHostofferRWArnoldJE. Otitis media following tympanostomy tube placement in children with IgG2 deficiency. Laryngoscope. 1995;105:1188-1190.
32.
HadfieldPJRowe-JonesJMBushA. Treatment of otitis media with effusion in children with primary ciliary dyskinesia. Clin Otolaryngol Allied Sci. 1997;22:302-306.
33.
RajenderkumarDBamiouDSirimannaT. Management of hearing loss in Apert syndrome. J Laryngol Otol. 2005;119:385-390.
34.
HampalSFloodLMKumarBU. The mini-grommet and tympanosclerosis. J Laryngol Otol. 1991;105:161-164.
35.
DingleAFFloodLMKumarBU. The mini-grommet and tympanosclerosis: results at two years. J Laryngol Otol. 1993;107:108-110.
36.
GordtsFClementPADerdeMP. Lens tube vs Donaldson tube: results of a prospective study comparing a new with a conventional ventilation tube. Clin Otolaryngol Allied Sci. 1993;18: 410-414.
37.
ShoneGRGriffithIP. Titanium grommets: a trial to assess function and extrusion rates. J Laryngol Otol. 1990;104:197-199.
38.
WeigelMTParkerMYGoldsmithMM. A prospective randomized study of four commonly used tympanostomy tubes. Laryngoscope. 1989;99:252-256.
39.
HeatonJMBinghamBJOsborneJ. A comparison of performance of Shepard and Sheehy collar button ventilation tubes. J Laryngol Otol. 1991;105:896-898.
40.
CholeRAHubbellRN. Antimicrobial activity of silastic tympanostomy tubes impregnated with silver oxide: a double-blind randomized multicenter trial. Arch Otolaryngol Head Neck Surg. 1995;121:562-565.
41.
CoatesHChaiFOatesJ. The use of surface treated and silver oxide impregnated tympanostomy tubes in reducing post-operative otorrhoea. Aust J Otolaryng. 1998;3:16-19.
42.
KinnariTJJeroJ. Experimental and clinical experience of albumin coating of tympanostomy tubes. Otolaryngol Head Neck Surg. 2005;133:596-600.
43.
HernJDJonathanDA. Insertion of ventilation tubes: does site matter?Clin Otolaryngol Allied Sci. 1999;24:424-425.
44.
HamptonSMAdamsDA. Perforation rates after ventilation tube insertion: does the positioning of the tube matter?Clin Otolaryngol Allied Sci. 1996;21:548-549.
45.
PearsonCRThomasMRCoxHJ. A cost-benefit analysis of the post-operative use of antibiotic ear drops following grommet insertion. J Laryngol Otol. 1996;110:527-530.
46.
SalamMACableHR. The use of antibiotic/steroid ear drops to reduce post-operative otorrhoea and blockage of ventilation tubes: a prospective study. J Laryngol Otol. 1993;107: 188-189.
47.
PoetkerDLindstromDPatelN. Ofloxacin otic drops vs neomycin-polymyxin B otic drops as prophylaxis against early postoperative tympanostomy tube otorrhea. Arch Otolaryngol Head Neck Surg. 2006;132:1294-1298.
48.
AltmanJSHaupertMSHamakerRA. Phenylephrine and the prevention of postoperative tympanostomy tube obstruction. Arch Otolaryngol Head Neck Surg. 1998;124:1233-1236.
49.
DawesPJBinghamBJRhysR. Aspirating middle ear effusions when inserting ventilation tubes: does it influence post-operative otorrhoea, tube obstruction or the development of tympanosclerosis?Clin Otolaryngol Allied Sci. 1991;16:457-461.
50.
YoungsRPGatlandDJ. Is aspiration of middle ear effusions prior to ventilation tube insertion really necessary?J Otolaryngol. 1988;17:204-206.
51.
BalkanyTJArenbergIKSteenersonRL. Ventilation tube surgery and middle ear irrigation. Laryngoscope. 1986;96:529-532.
52.
ShinkwinCAMurtyGESimoR. Per-operative antibiotic/steroid prophylaxis of tympanostomy tube otorrhoea: chemical or mechanical effect?J Laryngol Otol. 1996;110:531-533.
53.
KinsellaJBFentonJDonnellyMJ. Tympanostomy tubes and early post-operative otorrhea. Int J Pediatr Otorhinolaryngol. 1994;30:111-114.
54.
ObermanJDerkayC. Post-tympanostomy tube otorrhea. Am J Otolaryngol. 2004;25:110-117.
55.
GilesWDoharJIversonK. Ciprofloxacin/dexamethasone drops decrease the incidence of physician and patient outcomes of otorrhea after tube placement. Int J Pediatr Otorhinolaryngol. 2007;71:747-756.
56.
KocaturkSYardimciSYildirimA. Preventive therapy for postoperative purulent otorrhea after ventilation tube insertion. Am J Otolaryngol. 2005;26:123-127.
57.
ZipfelTWoodWStreetD. The effect of topical ciprofloxacin on postoperative otorrhea after tympanostomy tube insertion. Am J Otol. 1999;20:416-420.
58.
MorpethJFBentJPWatsonT. A comparison of cortisporin and ciprofloxacin otic drops as prophylaxis against post-tympanostomy otorrhea. Int Pediatr Otorhinolaryngol. 2001;61:99-104.
59.
NawasrehOAl-WeidanI. Prophylactic ciprofloxacin drops after tympanostomy tube insertion. Saudi Med J. 2004;25:38-40.
60.
EpsteinJBeaneJHubbellR. Prevention of early otorrhea in ventilation tubes. Otolaryngol Head Neck Surg. 1992;107:758-762.
61.
HochmanJBlakleyBAbdohAAleidH. Post-tympanostomy tube otorrhea: a meta-analysis. Otolaryngol Head Neck Surg. 2006;135:8-11.
Ah-TyeCParadiseJColbornD. Otorrhea in young children after tympanostomy-tube placement for persistent middle-ear effusion: prevalence, incidence and duration. Pediatrics. 2001;107:1251-1258.
64.
MandelECasselbrantMKurs-LaskyM. Acute otorrhea: bacteriology of a common complication of tympanostomy tubes. Ann Otol Rhinol Laryngol. 1994;103:713-718.
65.
DoharJGilesWRolandP. Topical ciprofloxacin/dexamethasone superior to oral amoxicillin/clavulanic acid in acute otitis media with otorrhea through tympanostomy tubes. Pediatrics. 2006;118:561-569.
66.
RolandPAnonJMoeR. Topical ciprofloxacin/dexamethasone is superior to ciprofloxacin alone in pediatric patients with acute otitis media and otorrhea through tympanostomy tubes. Laryngoscope. 2003;113:2116-2122.
67.
RolandPKreislerLReeseB. Topical ciprofloxacin/dexamethasone otic suspension is superior to ofloxacin otic solution in the treatment of children with acute otitis media with otorrhea through tympanostomy tubes. Pediatrics. 2004;113:40-46.
68.
RuoholaAHeikkinenTMeurmanO. Antibiotic treatment of acute otorrhea through tympanostomy tube: randomized double-blind placebo-controlled study with daily follow-up. Pediatrics. 2003;111:1061-1067.
69.
CarbonellRRuiz-GarciaV. Ventilation tubes after surgery for otitis media with effusion or acute otitis media and swimming: systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol. 2002;66:281-289.
70.
GilbertJ. Swimming and grommets: a prospective survey. N Z Med J. 1994;107:244-245.
71.
CohenHAKauschanskyAAshkenasiA. Swimming and grommets. J Fam Pract. 1994;38:30-32.
72.
BeckerGEckbergTGoldwareR. Swimming and tympanostomy tubes: a prospective study. Laryngoscope. 1987;97:740-741.
73.
ArcandPGauthierPBilodeauG. Post-myringotomy care: a prospective study. J Otolaryngol. 1984;13:305-308.
74.
GoldsteinNMandelEKurs-LaskyM. Water precautions and tympanostomy tubes: a randomized, controlled trial. Laryngoscope. 2005;115:324-330.
75.
JohnstonLFeldmanHParadiseJ. Tympanic membrane abnormalities and hearing levels at the ages of 5 and 6 years in relation to persistent otitis media and tympanostomy tube insertion in the first 3 years of life: a prospective study incorporating a randomized clinical trial. Pediatrics. 2004;114:e58-e67.
76.
BondingPTosM. Grommets versus paracentesis in secretory otitis media: a prospective, controlled study. Am J Otol. 1985;6:455-460.
77.
LildholdtT. Ventilation tubes in secretory otitis media: a randomized, controlled study of the course, the complications, and the sequelae of ventilation tubes. Acta Otolaryngol Suppl. 1983;398:1-28.
78.
StenstromRPlessIBBernardP. Hearing thresholds and tympanic membrane sequelae in children managed medically or surgically for otitis media with effusion. Arch Pediatr Adolesc Med. 2005;159:1151-1156.
79.
de BeerBSnikASchilderAG. The effect of otitis media in childhood on the development of middle ear admittance on reaching adulthood. Arch Otolaryngol Head Neck Surg. 2005;131:777-781.
80.
de BeerBASchilderAGIngelsK. Hearing loss in young adults who had ventilation tube insertion in childhood. Ann Otol Rhinol Laryngol. 2004;113:438-444.
81.
de BeerBASchilderAGZielhuisGA. Natural course of tympanic membrane pathology related to otitis media and ventilation tubes between ages 8 and 18 years. Otol Neurotol. 2005;26:1016-1021.
82.
ValtonenHTuomilehtoHQvarnbergY. A 14-year prospective follow-up study of children treated early in life with tympanostomy tubes: Part 2. Hearing outcomes. Arch Otolaryngol Head Neck Surg. 2005;131:299-303.
83.
ValtonenHJQvarnbergYHNuutinenJ. Otological and audiological outcomes five years after tympanostomy in early childhood. Laryngoscope. 2002;112:669-675.
84.
MandelEMRocketteHEBluestoneCD. Efficacy of myringotomy with and without tympanostomy tubes for chronic otitis media with effusion. Pediatr Infect Dis J. 1992;11:270-277.
85.
MawARBawdenR. Tympanic membrane atrophy, scarring, atelectasis and attic retraction in persistent, untreated otitis media with effusion and following ventilation tube insertion. Int J Pediatr Otorhinolaryngol. 1994;30:189-204.
86.
McDonaldSLangton HewerCDNunezDA. Grommets (ventilation tubes) for recurrent acute otitis media in children. Cochrane Database Syst Rev. 2008;(4):CD004741.
87.
EggerMJûniPBartlettCHolensteinFSterneJ. How important are comprehensive literature searches and the assessment of trial quality in systematic reviews? Empirical study. Health Technol Assess. 2003;7(1):1-76.
88.
El-SayedY. Treatment of recurrent acute otitis media chemoprophylaxis versus ventilation tubes. Aust J Otolaryngol. 1996;2:352-355.
89.
ChanLTakataGShekelleP. Evidence assessment of management of acute otitis media: II. Research gaps and priorities for future research. Pediatrics. 2001;108:248-254.
90.
FinitzoTFriel-PattiSChinnKBrownO. Tympanometry and otoscopy prior to myringotomy: issues in diagnosis of otitis media. Int J Pediatr Otorhinolaryngol. 1992;24:101-110.
91.
FieldsMJAllisonRSCorwinPWhitePSDohertyJ. Microtympanometry, microscopy and tympanometry in evaluating middle ear effusion prior to myringotomy. N Z Med J. 1993;106:386-387.
92.
PichicheroMPooleM. Comparison of performance by otolaryngologists, pediatricians, and general practitioners on an otoendoscopic diagnostic video examination. Int J Pediatr Otorhinolaryngol. 2005;69:361-366.
93.
BlomgrenKPohjavuoriSPoussaT. Effects of accurate diagnostic criteria on incidence of acute otitis media in otitis-prone children. Scand J Infect Dis. 2004;36:6-9.
94.
Markowitz-SpenceLBrodskyLSyedN. Anesthetic complications of tympanostomy tube placement in children. Arch Otolaryngol Head Neck Surg. 1990;116:809-812.
95.
HoffmannKThompsonGBurkeB. Anesthetic complications of tympanostomy tube placement in children. Arch Otolaryngol Head Neck Surg. 2002;128:1040-1043.
96.
American Academy of Pediatrics. Clinical practice guidelines: otitis media with effusion. Pediatrics. 2004;113:1412-1419.
American Academy of Pediatrics, American Academy of Family Physicians. Subcommittee on management of acute otitis media: diagnosis and management of acute otitis media. Pediatrics. 2004;113:1451-1465.
99.
Cincinnati Children’s Hospital Medical Center. Evidence Based Clinical Practice Guideline for Medical Management of Acute Otitis Media in Children 2 Months to 13 Years of Age. Guideline summary NGC-3958, 2004. www.cincinnatichildrens.org/svc/alpha/h/health-policy/guidelines.htm
100.
Alberta Medical Association. Guideline for the Diagnosis and Management of Acute Otitis Media. 2008. www.topalbertadoctors.org
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