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Evaluation of the Results and Complications of the Ventilation Tubes’ Setting Surgery in Patients with Serous Otitis Media

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Artigo Original Evaluation of the Results and Complications of the Ventilation Tubes’ Setting Surgery in Patients with Serous Otitis Media Avaliação de Resultados e Complicações da Cirurgia de Colocação de Tubos de Ventilação em Pacientes com Otite Media Serosa José Ricardo Testa*, Spyros Cardoso Dimatos**, Bárbara Greggio***, Juliana Antoniolli Duarte***. * Doctor of Medicine. Medical Faculty Otorhinolaryngology. ** Master Pediatric Otolaryngology. Medical Graduate Student. *** Medical Residency. Resident. Instituition: UNIFESP / EPM - Federal University of São Paulo Paulista School of Medicine - Department of Pediatric Otolaryngology. São Paulo / SP - Brazil. Mail Address: Juliana Antoniolli Duarte - Rua Pedro de Toledo, 947 - 2º andar - Vila Clementino - São Paulo / SP - Brazil - ZIP CODE: 04039-002 - Telefax: (+55 11) 5539-5378 - E-mail: [email protected] Article received in em March 1, 2010. Article approved in March 13, 2010. SUMMARY Introduction: Tympanostomy for ventilation tube setting is one of the surgeries more frequent performed in patients in the pediatric age group. Objective: This study evaluates the indications and complications post operatives more frequents in this otorhinolaryngological practice in a school hospital. Method: It was realized a series type retrospective study of cases in which 109 pediatric patients, that have received ventilation tube were evaluated as for the post operative indication and attendance for the otorhinolaryngology sector of the Paulista Medicine School for 2007 to 2008. Results: The age’ average found was 7,37 years, being the majority of the patients of the male sex (59,63%). All the cases have had as surgical indication serous otitis media. The taxes of complications found were lower than those related for the literature with 3,43% of residual perforation with necessity of surgical re intervention and 5,47% do not presented a audiometric improvement needing a new insertion of ventilation tube. Conclusion: The results found suggest that in our service there are lower rates of postoperative otorrhea, tube reinsertion, less tubes surgically removed and a similar rate of residual perforations that that one described in the literature for surgical placement of ventilation tubes in patients with SOM. Keywords: otitis media, middle ear ventilation, results evaluation (health care). RESUMO Introdução: Timpanotomia para colocação de tubo de ventilação é uma das cirurgias mais frequentes realizadas em pacientes na faixa etária pediátrica. Objetivo: Esse estudo avalia indicações e complicações pós-operatórias mais frequentes nesta prática otorrinolaringológica em um hospital escola. Método: Foi realizado um estudo retrospectivo tipo série de casos no qual 109 pacientes pediátricos, que receberam tubos de ventilação, foram avaliados quanto à indicação e acompanhamento pós-opera- tório pelo setor de otorrinolaringologia da Escola Paulista de Medicina durante os anos de 2007 a 2008. Resultados: A idade média encontrada foi de 7,37 anos, sendo a maioria dos pacientes do sexo masculino (59,63%). Todos os casos tiveram como indicação cirúrgica otite média serosa. As taxas de complicações encontradas foram menores que as relatadas pela literatura com 3,43% de perfuração residual com necessidade de reintervenção cirúrgica e 5,47% não apresentaram melhora audiométrica, necessitan- do de nova inserção de tubo de ventilação. Conclusão: Os resultados encontrados sugerem que em nosso serviço há menores taxas de otorreia pós-opera- tória, reinserção de tubos, menor número de tubos removidos cirurgicamente e taxa semelhante de perfurações residuais que a descrita na literatura para a cirurgia de colocação de tubo de ventilação em pacientes com OMS. Palavras-chave: otite média, ventilação da orelha média, avaliação de resultados (cuidados de saúde). Intl. Arch. Otorhinolaryngol., São Paulo - Brazil, v.14, n.1, p. 90-94, Jan/Feb/March - 2010. 90 Evaluation of the results and complications of the ventilation tubes’ setting surgery in patients with serous otitis media. Testa et al. Tonsillectomy and myringotomy should be shown not only INTRODUCTION to treat OME (6). Otitis media is the most common disease in childhood Despite the placement of tympanostomy tubes is (1). It is estimated that about 90% of children have suffered a simple procedure, complications can occur. Tympanic at least 1 episode of acute otitis before 2 years of age (2). sequelae after myringotomy for insertion of tympanostomy Hearing loss consequent to the damage involves otitis tubes are common but are generally transient (otorrhea) more frequently found in this population and may be or do not affect the function (tympanosclerosis) and is responsible for delayed acquisition of language, cognitive reported to occur in 25% to 33% of patients (7). One of and psychosocial development. the most common complications are perforation and residual is reported in about 2% of patients receiving tube The placement of tympanostomy tubes after of short duration, type Shepard, and 17% of patients myringotomy for treatment of otitis media is the surgical receiving long-term tube type Paparella (6). Studies procedure most commonly performed in children (1,2,3). indicate that tubes remain leased for more than 30 months This procedure can be used to treat serous otitis media have a lower chance of spontaneous extrusion and higher (seromucous) and to treat recurrent acute otitis media residual risk of perforation (2,8). It is estimated that 7 to (1.2). Both diseases can be associated with hearing loss and 8% of the tubes inserted should be removed by the doctor damage to the middle ear structures. (2). Anesthetic complication is reported in cases 1:50.000 (6). In 2004 a guideline (4) was published, updating the first guideline of 1995 BLUESTONE and KLEIN (5), and reviewing the indications for placement of tympanostomy tubes METHOD transtympanic following: A - Secretory otitis media (WHO), no improvement after According to the American Academy of Pediatrics, antibiotic treatment and persisting for 3 months or more the guideline on secretory otitis media, the patient is in bilateral cases or 6 months or more in unilateral cases. considered a candidate for surgery when the diagnosis is B - Recurrent acute otitis media especially when there is established by WHO for 4 months or longer with persistent failure of antibiotic prophylaxis. In the presence of 3 hearing loss and myringotomy with ventilation tube insertion episodes of AOM in the last 6 months or 4 episodes in is the preferred myringotomy only (6). This guideline does the last year. not recommend Implementation of adenoidectomy in the C -Recurrent secretory otitis media episodes whose same operative time, unless there is a distinct Indication for duration is considered excessive, or 6 months within 1 nasal SYMPTOMS such as nasal obstruction or chronic year. adenoitide. Adenoidectomy Should Be Used to treat only D -Suspected suppurative complications the need for 2nd WHO intervention and in such cases E - Dysfunction of the Eustachian tube, even with absence Should Be Performed adenoidectomy and myringotomy of middle ear effusion when the patient presents with with or without insertion of ventilation tubes (6). recurrent signs and symptoms not relieved by medical Tonsillectomy and myringotomy should be shown not only treatment. to treat OME (6). F - Barotrauma, especially in the prevention of recurrent episodes of aircraft such as trips or treatment with We Cconducted a retrospective case series with hypobaric camera. data collection for the Study of medical records. We included all Patients Between 2 and 18 years old undergoing According to the American Academy of Pediatrics, a myringotomy for insertion of ventilation tubes made in Our guideline on secretory otitis media, a patient is considered teaching hospital During the years 2007 and 2008 by a a candidate for surgery when the diagnosis is established by team of pediatric otolaryngology. We excluded Patients WHO for 4 months or longer with persistent hearing loss who, despite being shown the insertion of ventilation tube, and myringotomy with ventilation tube insertion is the underwent myringotomy alone. preferred myringotomy only (6). This guideline does not recommend implementation of adenoidectomy in the Analyzed the data included age, gender, Indication same operative time, unless there is a distinct indication for / diagnosis, Audiogram and Impedance pre operative, nasal symptoms such as nasal obstruction or chronic intraoperative and postoperative complications, length of adenoitide. Adenoidectomy should be used to treat only the tube, Necessary to remove the tube in the operating the need for WHO 2nd intervention, and in such cases room and postoperative Audiogram. We Evaluated the should be performed adenoidectomy and myringotomy Indications for surgery and postoperative evolution of with or without insertion of ventilation tubes (6). these patients. Intl. Arch. Otorhinolaryngol., São Paulo - Brazil, v.14, n.1, p. 90-94, Jan/Feb/March - 2010. 91 Evaluation of the results and complications of the ventilation tubes’ setting surgery in patients with serous otitis media. Testa et al. 35 450 13 30 400 25 350 20 300 188 Tubes 15 250 0** 10 200 5 150 Number of 201* 4 0 100 7 1a 2a 3a 4a 5a 6a 7a 8a 9a 10a >10 50 49** a 11* 0 preoperatively postoperatively Tubes 2 6 16 28 27 28 19 17 6 18 34 GAP Curve A Curve B Curve C * McNemar test, p< 0,001 Figure 1. Age distribution of patients who received ventilation ** McNemar test, p< 0,001
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