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Current Recommendations On Management Of Otitis Media With Effusion

(source-National Collaborating Centre for Women's and Children's Health, UK)

In view of a lot of controversy over the management of otitis media with effusion, it is helpful to know the recommendations by a group that has studied this on basis of extensive research, randomized trials and meta analysis. These recommendations are for your information and maybe followed, with scope for modifications, but should be supported with adequate proof. In the age of consumerism, especially as a draft of these guidelines are available to the general public also, it is pertinent that we are aware of this document. A full text of this document is available at www.nice.org.uk/CG060

Otitis media with effusion (OME) is a condition characterised by a collection of fluid within the middle ear without signs of acute inflammation. It is most common in young children, with a bimodal peak at 2 and 5 years of age. Eighty percent of children will have had a least one episode of OME by the age of 10 years. At age 7–8 years, about 8% of children will have middle ear effusions. The mean duration of effusions is 6–10 weeks but some cases are more persistent. The mean duration of effusions is 6–10 weeks but some cases are more persistent.

OME is known to be a fluctuating condition with symptoms that vary with time and with age. The main symptom of OME is impaired hearing because the middle ear effusion causes a conductive hearing loss by reflection of the sound energy at the air–fluid interface. The diagnosis is based on suspicion of hearing loss, clinical history, clinical examination of the ears and appropriate audiometry and tympanometry.

While most cases of OME will resolve spontaneously, some children will need intervention because of the effects of hearing loss. This intervention may take the form of educational and social action or the provision of a hearing aid to minimise the impact of the hearing loss. No non- surgical intervention has yet been shown conclusively to be of benefit. Surgical management usually takes the form of myringotomy and insertion of a ventilation tube (grommet), with or without adenoidectomy.

Children with cleft palate are particularly susceptible to OME because of the impaired function of the Eustachian tube that results from the palatal anomaly, which in turn leads to a failure of middle ear ventilation. Similarly, children with Down's syndrome have a high incidence of OME, partly because of their impaired immunity and mucosal abnormality, with resulting susceptibility to ear infection. These groups of children need particular surveillance for OME so that proper action can be taken.

Formal assessment of a child with suspected OME should include:

• clinical history taking, focusing on:
– poor listening skills
– indistinct speech or delayed language development
– inattention and behaviour problems
– hearing fluctuation
– recurrent ear infections or upper respiratory tract infections
– poor educational progress
• clinical examination, focusing on:
-otoscopy
– general upper respiratory health
– general developmental status

• hearing testing, which should be carried out by trained staff using tests suitable for the developmental stage of the child, and calibrated equipment

• tympanometry.

Children with persistent bilateral OME documented over a period of 3 months with a hearing level in the better ear of 25–30 dBHL or worse averaged at 0.5, 1, 2 and 4 kHz (or equivalent dBA where dBHL not available) should be considered for surgical intervention. Once a decision has been taken to offer surgical intervention for OME in children, the insertion of ventilation tubes is recommended. Adjuvant adenoidectomy is not recommended in the absence of persistent and/or frequent upper respiratory tract symptoms.

Hearing aids should be offered to children with persistent bilateral OME and hearing loss as an alternative to surgical intervention where surgery is contraindicated or not acceptable. Hearing aids should normally be offered to children with Down's syndrome and OME with hearing loss. Insertion of ventilation tubes at primary closure of the cleft palate should be performed only after careful otological and audiological assessment. Insertion of ventilation tubes should be offered as an alternative to hearing aids in children with cleft palate who have OME and persistent hearing loss.

For information to ENT Consultants

Dr. M.P. Manoj,
Consultant in Otolaryngology,
Dr. Manojs ENT Superspeciality Institute And Research Centre,
2/44-A, East Hill Junction,
West Hill Post,
Calicut 673005
Phone:
+91 495
2386060
Mobile:
+91 989
5888001
Website
:  www.drmanojsent.com
 
 
 
Otology Master Class
From the Organizing desk

Dear friends,

MESIARC CME is here again. We have always strived to bring you the best in Otology, over the past 10 years, Our live surgery workshops, have focused on cutting edge surgery, detailed teaching, scientific deliberations of the highest order and top class video coverage from one of the most advanced otological theatre suites in the world this time, we are focusing on the enigma of budding otologists - cholesteatoma and Otosclerosis. Two very diverse conditions, but requiring surgical expertise of the highest order to deliver good results. The two-day surgical workshops will feature both myself and a luminary in Otology, Dr. Ashesh Bhumker from Thane, Mumbai and we would be demonstrating in detail the finer aspects of surgical techniques that can be adapted by a keen otologist to sustain good results over time.

We have lined up an array of diverse cases- and the techniques that we intend to demonstrate include minimal access stapedotomy, Laser stapes surgery, stapes surgery with stapes head amputation for tendon preservation, bone obliteration technique for cholesteatoma, a variety of grafting techniques, intact canal wall tympanoplasty for limited cholesteatoma and a series of revision surgeries.

Do send in your registrations early as we have to limit attendance to 70 seats. A smaller crowd is ideal for active discussions which is something so characteristic of MESIARC CME programs and we do not want to deviate from that agenda.


Yours truly,

Manoj MP  
Organizing chairman

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From the Organizing desk

Mesiarc brings you a unique live surgical workshop- a demonstration of both endoscopic and microscopic otologic skills.

Otologic surgery is special for its intricate anatomy, extreme precision and attention to detail. Traditionally done with the operating microscope, and now in some centers across the world with the endoscope, the repetoire of the art is widening.

Confusion persists. Advocates of endoscopic work claim that the microscope is passe, and traditional surgeons laugh off the ability of the one handed

The truth lies somewhere in between; there are specific conditions that require either of both of the techniques. Dogmatism, they say, is the end of science.

Mesiarc brings you a unique live surgical workshop- a demonstration of both endoscopic and microscopic otologic skills.

MESIARC has always stood for dissipation of knowledge and the live surgical workshops are not pubilicity events, nor are they grandiose. We have just one agenda- to educate.

This workshop with a difference aims to demonstrate both endoscopic and microsopic skills in otologic surgery, while attempting to define which is more suitable for what. Do come and enjoy!


Yours truly,

Manoj MP  
Organizing chairman

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