Placement of ear ventilation tubes does not improve long-term hearing threshholds and increases scarring

Article Outline

• Stenstrom R, Pless IB, Bernard P. Hearing thresholds and tympanic membrane sequelae in children managed medically or surgically for otitis media with effusion. Arch Pediatr Adolesc Med 2005;159:1151-6
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Stenstrom R, Pless IB, Bernard P. Hearing thresholds and tympanic membrane sequelae in children managed medically or surgically for otitis media with effusion. Arch Pediatr Adolesc Med 2005;159:1151-6 

Question Does the use of ventilation tube insertion in children with otitis media with effusion have an effect on hearing thresholds and tympanic membrane pathologic abnormalities?

Design Prospective cohort study.

Setting Tertiary care children’s hospital, otorhinolaryngology and audiology service.

Participants Patients aged 8 to 16 years who participated in a randomized controlled trial of medical vs surgical (ventilation tube [VT]) treatment for recurrent otitis media with effusion at ages 2.5 to 7 years.

Methods One hundred thirteen of 125 children who had participated in the trial underwent blinded audiometric, tympanometric, otomicroscopic, and parental questionnaire evaluation 6 to 10 years following the trial. Thirty of 56 medical subjects received ventilation tubes and 18 of 57 VT subjects received more than 1 set of tubes. To evaluate sequelae risk associated with ventilation tubes independent of disease severity, the authors compared 27 medical subjects who never received ventilation tubes and 38 subjects randomized to VT who only received 1 set of tubes.

Outcomes Hearing thresholds and tympanic membrane sequelae.

Results Tympanic membrane pathologic abnormalities were present in 81% of VT subjects and 19% of medical subjects (relative risk, 4.4; 95% confidence interval, 2.2-9.9). Hearing thresholds were 2.1 to 8.1 dB higher in subjects treated with tubes (P=.005).

Conclusions In children who were candidates for ventilation tube insertion randomly assigned to receive medical or VT treatment for otitis media with effusion, elevated hearing thresholds and tympanic membrane pathologic abnormalities were more common in VT subjects 6 to 10 years after insertion.

Comment This article reports the findings of a 6 to 9 year follow-up assessment in children enrolled in a randomized controlled trial that compared the surgical insertion of a “T” type VT with antibiotic prophylaxis to manage OME. When comparing those children who received medical management (MM) and never had VT to 38 children who had surgical management (SM) with a VT placed in the initial trial but never required additional VT insertions, tympanosclerosis was 4.5 times more common in the SM (66%) compared to the MM children (15%). Other tympanic membrane pathology was 9.9 times more common in the SM (37%) compared to the MM children (4%). Children with a VT inserted had higher average mean hearing thresholds between 2.13-8.17 dB at all tested frequencies; and the relative risk of having a hearing threshold greater than 15 dB was 3.3 times higher in SM compared to MM children. One cautionary note is that long term “t-tubes,” now rarely used, compared to button tubes may cause more sequelae that impact hearing even when removed after 12-14 months. These findings support the recommendation that otherwise normal children with persistent OME for 4 months or longer only have surgery if their hearing thresholds are 40 dB or higher.