It is a decision faced by millions of families of children with recurrent or chronic otitis media with effusion (non-infected fluid in the middle ear) each year. Out of concern regarding long-term effects like hearing loss and potential developmental delays, about a million such families choose ear tubes annually, opting for surgery that carries risks of its own.
New research by the RTI-University of North Carolina Evidence-based Practice Center, though, may have practitioners reconsidering their clinical recommendations to families. The systematic review of more than 40 studies found that implanting tubes in the ears of children who have persistent or recurrent episodes of otitis media with effusion (OME) improves hearing over a short period but is less likely to improve long-term cognitive and functional development.
"Surgery can certainly help ease pain associated with ear pressure changes in the middle ear, and even improve hearing in the short term, but we found no evidence that surgical intervention improves longer term hearing, speech, language, or other functional outcomes in normally developing children," said Michael Steiner, MD, chief of general pediatrics and adolescent medicine at the University of North Carolina School of Medicine, who served as the review's lead medical advisor and senior author.
OME is a collection of fluid in the middle ear without signs or symptoms of acute ear infection. The fluid decreases middle ear function, leading to hearing loss and occasional pain from the pressure changes. As many as 90 percent of children have at least one episode of OME by age 10, and OME is a primary reason for children to undergo surgery.
Myringotomy and tube placement is a procedure in which a tiny incision is created in the eardrum, and then a small tube is placed to relieve pressure and fluid build-up. This can be done alone or sometimes is also done with adenoidectomy, where tissue is removed from the back of the throat. In the United States these are two common surgical treatments for OME.
The systematic review, published online in Pediatrics, examined 41 studies and found that, compared with watchful waiting or myringotomy alone, implanting tubes decreased middle ear effusion and improved hearing up to nine months post surgery. Limited evidence suggested that tube placement increased the rate of prolonged discharge from the ear or calcification of tissues in the ear compared with no ear surgery or just myringotomy.
Adenoidectomy also reduced time with ear infections and improved hearing up to two years compared with no treatment or as an adjunct to myringotomy; rarely, it increased the risk of postsurgical hemorrhage.
"With the large number of tube insertions and adenoidectomies done on children each year, more research needs to be done to assist clinicians and parents in understanding the level of improvement in quality of life and other patient-centered outcomes that these common procedures offer, especially for periods longer than 24 months." said Ina Wallace, PhD, senior research psychologist at RTI International and the study's lead author. "Our research showed that tubes and adenoidectomy seem to be effective in the short term, although they carry some risks. We found evidence that tubes may not make a difference in hearing and functional outcomes over one or two years or longer, but less is known about the long-term outcomes for adenoidectomy."
The full report sought to clarify the benefits or harms of interventions for OME among adults but found no suitable evidence.
RTI-UNC Evidence-based Practice Center is a collaboration between RTI and the five health professions schools and the Cecil G. Sheps Center for Health Services Research at UNC. It is funded by the Agency for Healthcare Research & Quality.UNC Media Contact: Danielle M. Bates, T 919-843-9714, C 949-842-0680, email@example.com
RTI Media Contact: Lisa Bistreich-Wolfe, T 919-316-3596, firstname.lastname@example.org
Danielle Bates | EurekAlert!
Multi-year study finds 'hotspots' of ammonia over world's major agricultural areas
17.03.2017 | University of Maryland
Diabetes Drug May Improve Bone Fat-induced Defects of Fracture Healing
17.03.2017 | Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke
The Institute of Semiconductor Technology and the Institute of Physical and Theoretical Chemistry, both members of the Laboratory for Emerging Nanometrology (LENA), at Technische Universität Braunschweig are partners in a new European research project entitled ChipScope, which aims to develop a completely new and extremely small optical microscope capable of observing the interior of living cells in real time. A consortium of 7 partners from 5 countries will tackle this issue with very ambitious objectives during a four-year research program.
To demonstrate the usefulness of this new scientific tool, at the end of the project the developed chip-sized microscope will be used to observe in real-time...
Astronomers from Bonn and Tautenburg in Thuringia (Germany) used the 100-m radio telescope at Effelsberg to observe several galaxy clusters. At the edges of these large accumulations of dark matter, stellar systems (galaxies), hot gas, and charged particles, they found magnetic fields that are exceptionally ordered over distances of many million light years. This makes them the most extended magnetic fields in the universe known so far.
The results will be published on March 22 in the journal „Astronomy & Astrophysics“.
Galaxy clusters are the largest gravitationally bound structures in the universe. With a typical extent of about 10 million light years, i.e. 100 times the...
Researchers at the Goethe University Frankfurt, together with partners from the University of Tübingen in Germany and Queen Mary University as well as Francis Crick Institute from London (UK) have developed a novel technology to decipher the secret ubiquitin code.
Ubiquitin is a small protein that can be linked to other cellular proteins, thereby controlling and modulating their functions. The attachment occurs in many...
In the eternal search for next generation high-efficiency solar cells and LEDs, scientists at Los Alamos National Laboratory and their partners are creating...
Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are less stable. Now researchers at the Technical University of Munich (TUM) have, for the first time ever, produced a composite material combining silicon nanosheets and a polymer that is both UV-resistant and easy to process. This brings the scientists a significant step closer to industrial applications like flexible displays and photosensors.
Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are...
20.03.2017 | Event News
14.03.2017 | Event News
07.03.2017 | Event News
29.03.2017 | Health and Medicine
29.03.2017 | Earth Sciences
29.03.2017 | Trade Fair News