Long term outcomes for children who undergo ear tube placement surgery

April 18, 2005

CHICAGO - Infants and young children who undergo surgery to insert ventilation tubes in their ears as a treatment for ear infections have hearing levels comparable to normal children 14 years later, although children with more serious disease may require repeat procedures or other ear surgery, according to two studies in the April issue of Archives of Otolaryngology-Head & Neck Surgery, one of the JAMA/Archives journals.

Ear infections (otitis media or OM) and ear infections with accumulated fluid (otitis media with effusion or OME) bring young children into physicians' offices more than any other childhood disease, according to background information in the article. Recurrent acute otitis media (RAOM) and otitis media with effusion are the main reason for the insertion of ventilation tubes (VT) in the ear. Minor surgery to drain the ear and insert tubes in the ear is the most common surgical procedure among young children in the United States. Instant improvement of hearing is one of the beneficial effects of the surgery and, the authors suggest, may be associated with long-term reduction in risk of subsequent language, educational and developmental impairments.

Hannu Valtonen, M.D., Ph.D.,of Kuopio University Hospital, Kuopio, Finland, and colleagues report on the results of follow-up checkups 14 years following surgery for 237 children who had tubes inserted to treat ear infections at the age of five to16 months. The children had also participated in an earlier follow-up visit five years following the surgery. In addition to assessing their hearing levels, children were assessed on whether the ear had healed, for a history of repeat procedures, for abnormal outcomes and on whether they required more extensive ear surgery.

The hearing level of healed ears was comparable to that of age-matched normal ears. "Ear surgery, which sometimes becomes necessary, is not hazardous for hearing, as such, but in the case of chronic middle ear infection may be insufficient to retain normal hearing or restore it to normal levels," the authors write.

At the 14 years' follow-up 177 (74.7 percent) of the children's ears had healed, up from 156 (65.8 percent) at five years following surgery. The number of abnormal outcomes decreased from 81 (34.2 percent) at five years to 60 (25.3 percent) at 14 years. Abnormal outcomes were more common when the child had an ear infection with accumulated fluid, or had required three or more tube insertions. Repeated tube insertion and other ear surgery was also more common in those with the more serious condition.

"Based on our results, we conclude that tympanostomy tube insertion early in life, and repeated if necessary, for OME or RAOM is a safe and useful treatment method," the authors conclude. "Parents should be informed of the long follow-up, of the possible need for repeated VT insertion, and of potential sequelae that sometimes necessitate surgical intervention. Patients healed after five years do not need further follow-up."
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(Arch Otolaryngol Head Neck Surg. 2005;131:293-303. Available post-embargo at www.archoto.com.)

For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or email mediarelations@jama-archives.org.

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