Is IV access necessary for myringotomy with tubes?

October 31, 2007     Arthur H. Allen, DO


A retrospective chart review was conducted at a community-based hospital to determine whether intravenous access is necessary during the performance of myringotomy with tube insertion. The study included 50 pediatric patients divided equally into 2 groups: group 1, who did not have intravenous access established before the procedure, and group 2, who did have intravenous access established. To be enrolled, patients in both groups had to be ≤12 years of age, have an American Society of Anesthesiologists physical status classification of P1 or P2, and had to have undergone no adjunctive procedure with the myringotomy. Induction time was significantly shorter in group 1 (average: 6.96 ± 2.72 minutes) than in group 2 (average: 9.80 ± 3.82 minutes; p = 0.004). Operating time and total operating room time were not significantly different between the two groups. Additionally, 24 of 25 patients in group 1 had their pain managed with acetaminophen or no medication at all, while 9 of 25 group 2 patients received acetaminophen and 13 received intravenous pain medication. Interestingly, no patients in group 1 required antiemetics, whereas 4 patients in group 2, who were given intravenous or intramuscular narcotics, received antiemetic medications. These findings indicate that myringotomy with tube insertion can be safely accomplished without establishing intravenous access. Induction times and time under general anesthesia were significantly increased when intravenous access was obtained. The findings also suggest that acetaminophen provides adequate postoperative pain control in this patient population and that the use of intravenous or intramuscular narcotics increases the risk of postoperative nausea.

Myringostapediopexy after tympanomastoidectomy

August 31, 2007     Matthew Taljebini, MD; Eric P. Wilkinson, MD; Jose N. Fayad, MD

A 53-year-old man presented with chronic otitis media in the right ear and a cholesteatoma in the right ear. Audiometric testing revealed a high-frequency sensorineural hearing loss in both ears and a mixed hearing loss in the right ear.

A comparison of outcomes following tympanostomy tube placement or conservative measures for management of otitis media with effusion

August 31, 2007     Svetlana Diacova, MD; Thomas J. McDonald, MD
We obtained the charts of 183 patients (197 ears) who had undergone surgery for chronic otitis media (COM), and we reviewed their otic histories to analyze the series of events that ultimately culminated in surgery. All ears had originally been treated for otitis media with effusion (OME); 125 ears had been treated with tympanostomy tube placement, and 72 ears had been treated with conservative measures. Our goal was to compare the influence that these two strategies had on the subsequent development of COM and its sequelae (i.e., retraction pockets, tympanic membrane perforations, and cholesteatomas) and thereby determine which strategy is preferable. We found that although retraction pockets developed in a significantly higher proportion of the tympanostomy-treated ears than the conservatively treated ears (58 vs. 35%; p < 0.01), a significantly greater percentage of retractions in the tympanostomy-treated ears were mild and situated in the anterior part of the tympanic membrane (52 vs. 32%; p < 0.05). Moreover, severe retractions were significantly more common in the conservatively treated ears (40 vs. 16%; p < 0.02); the incidence of complete retractions in the two groups of ears was similar (tympanostomy: 32%; conservative treatment: 28%). Cholesteatomas developed in a significantly lower percentage of tympanostomy-treated ears (67 vs. 81%; p < 0.05), and the incidence of large cholesteatomas that involved the tympanic and mastoid cavities was likewise significantly lower in these ears (44 vs. 69%; p < 0.05). There was no significant difference in the incidence of tympanic membrane perforations. Finally, even though all of these ears eventually required surgery for COM, the tympanostomy-treated ears required significantly fewer repeat surgeries (16 vs. 28%; p < 0.05) and significantly fewer radical modified tympanomastoidectomies (30 vs. 44%; p < 0.05). Therefore, we conclude that myringotomy with insertion of tympanostomy tubes to treat OME is superior to conservative treatment.

Unilateral hearing impairment in Oman: A community-based cross-sectional study

April 30, 2007     Mazin Al Khabori, FRCS (ENT); Rajiv Khandekar, Dip (Epi), MS (Ophth)

Cerebrospinal fluid otorrhea presenting in complicated chronic suppurative otitis media

March 31, 2007     Vikram Bhat, MS, DNB, MNAMS (ORL-HNS); Dandinarasaiah Manjunath, MBBS

AOM and AOMT are different entities

September 30, 2006     Michael D. Poole, MD, PhD
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