Breda, M

Guimarães, J

Menezes, A

Pereira, S

Ribeiro, D

Silva, D

Silva, L

English

Institutional repository of Hospital de Braga

PROFILE OF CHILDREN IN RISK OF NEW SURGICAL INTERVENTION DUE TO OTITIS MEDIA WITH EFFUSIONServiço	de	Otorrinolaringologia	e	Cirurgia	Cérvico-FacialFP	OT4Miguel Sá Breda, Sara Pereira, Ana Menezes, Diana Silva, Joana Guimarães, Daniela Ribeiro, Luís Dias* - Otorhinolaryngology and Head and Neck Surgery Department Hospital de Bragawithout conflicts of interest to	declare1. INTRODUCTIONNome	autor|	ServiçoPROFILE OF CHILDREN IN RISK OF NEW SURGICAL INTERVENTION DUE TO OTITIS MEDIA WITH EFFUSIONü Presence of middle ear effusion without activeacute infection, with a non-perfuratedtympanic membraneü Most common cause of hearing loss in childrenü Few symptoms associatedOtitis Media With Effusion (OME)Epidemiology• Until 10 years old, 90% at least have 1 episode• The majority is solved within 3 months, but 5 to10% lasts 1 or more years• 30 to 40 % of the children have recurrent OMESubcommittee on Otitis Media With Effusion Pediatrics (2004)PROFILE OF CHILDREN IN RISK OF NEW SURGICAL INTERVENTION DUE TO OTITIS MEDIA WITH EFFUSIONMain AimØ To identify the risk factors for children receiving additional myringotomy with TVT after the first one20% may need another mTVT within 2 yearsSurgical TreatmentMyringotomy with trans-tympanic ventilation tube (mTVT)in Rosenfeld RM (2005)in Boston M et al. (2003)2. METHODSNome autor| ServiçoPROFILE OF CHILDREN IN RISK OF NEW SURGICAL INTERVENTION DUE TO OTITIS MEDIA WITH EFFUSIONMethodsü Retrospective analysis of medical recordsü 6 Years - January 2009 to December 2014 ü Young patients (age < 18 ) who underwent mTVT becauseof OME – 2 Groupsü mTVT indications:Bilateral – OME > 3 monthsUnilateral – OME > 6 monthsü Studied Variables:• age of 1st mTVT• concomitant adenoidectomy• estimated indwelling period of TVT• postoperative otorrhea (1st mTVT)• perioperative upper airway recurrent infections• history of allergies• preoperative eosinophilia• postoperative complicationsExclusion Criteria:• Age > 18y• Syndromic Children (Down’ssyndrome ...)• Craniofacial anomalies• Cleft Palate• Perfurated Chronic Otitis Media Control Group (CG)• 1 mTVT55 children97 earsStudy Group (SG)• ≥ 2 mTVT28 children55 ears3. RESULTS & DISCUSSIONPROFILE OF CHILDREN IN RISK OF NEW SURGICAL INTERVENTION DUE TO OTITIS MEDIA WITH EFFUSIONResultsTotal Patients: n= 83Total Ears: n= 152Nome	autor|	ServiçoPROFILE OF CHILDREN IN RISK OF NEW SURGICAL INTERVENTION DUE TO OTITIS MEDIA WITH EFFUSIONSG CG p valuePatients (n) 28 55male - % (n) 60,7%(17)52,7% (29) NS*female - % (n) 39,3%(11)47,3% (26)Concomitant Adenoidectomyat 1st mTVT - % (n)93% (26)98,2% (54)NS*Mean age at 1st mTVT(± sd) - years4,8(±2,6)6,3(±2,8)0,02**Ears (n) 55 97Mean indwelling period of 1stTVT - months 9,1 12,1 <,oo1**No. of mTVT2x - % (n) 82%(23)-3x - % (n) 18%(5)-Results* - χ2-test** - t-test✔✔ü the mean ge of the 1st m VT and the mean indwelling period of TVT are significantly associated to another mTVTPROFILE OF CHILDREN IN RISK OF NEW SURGICAL INTERVENTION DUE TO OTITIS MEDIA WITH EFFUSIONPerioperative upper airway recurrent infections Postoperative otorrhea64%40%0%10%20%30%40%50%60%70%SG CG56%12%0%10%20%30%40%50%60%SG CGp<0,001*p =0,036** - χ2-testü the postoperative otorrhea and the perioperative upper airway tractrecurrent infections are significantly associated to another mTVTPROFILE OF CHILDREN IN RISK OF NEW SURGICAL INTERVENTION DUE TO OTITIS MEDIA WITH EFFUSION39%20%0%5%10%15%20%25%30%35%40%45%SG CGHistory of allergiesp<0,001**NS*15%0%0%2%4%6%8%10%12%14%16%SG CGPostoperative complicationsPreoperativeeosinophilia39%36%35%35%36%36%37%37%38%38%39%39%40%SG CGNS*Ref.	 in	Manual	of Pediatric Hematology andOncology 4th	ed.	Lanzkowsky (2005)Eosinophilia >400 cells/mm3Postoperative complications in	SG	(n=6)Tympanic perfuration (n) 5Tympanic granulation (n) 2Tympanic retraction (n) 1ü Postoperative complications after the 1st mTVT are significantlyassociated to children who need another mTVT* - χ2-test * - χ2-test ** - Fisher’s exact testPROFILE OF CHILDREN IN RISK OF NEW SURGICAL INTERVENTION DUE TO OTITIS MEDIA WITH EFFUSIONBinary logistic regressionIs  there any risk factor that can lead to re-intervention?Age of 1st mTVTPerioperative upper airway recurrent infectionsAbsence of postoperative otorrheaTVT extrusion in less than 12 months*✔1Odds Ratio (95% CI)✔*Protective FactorRisk Factor0,23 (0,05-1,08)  p=0,05*157 (14-1742)  p<0,001*0,59 (0,10-3,47)  p = 0,59 - NS1,21 (0,85-1,74)  p = 2,93 - NSR2 Nagelkerke = 68,5%4. CONCLUSIONNome	autor|	ServiçoPROFILE OF CHILDREN IN RISK OF NEW SURGICAL INTERVENTION DUE TO OTITIS MEDIA WITH EFFUSIONConclusionThe profile of children who are at risk of new mTVTdue to OME:ü TVT extrusion in less than 12 monthsü Postoperative otorrheaØ Children who need new mTVT are statisticallyassociated to more postoperative complicationsmiguelbreda@gmail.comTHANK YOU FOR YOUR ATTENTION

Profile of children in risk of new surgical intervention due to otitis media with effusion

http://repositorio.hospitaldebraga.pt/bitstream/10400.23/1037/1/FP%20OT4.pdf

Profile of children in risk of new surgical intervention due to otitis media with effusion

Abstract

Similar works

Full text

Available Versions

Institutional repository of Hospital de Braga