Sidell Douglas, Hunter Lisa L, Lin Li, Arjmand Ellis
Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
Division of Audiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Otolaryngol Head Neck Surg. 2014 Jun;150(6):1048-55. doi: 10.1177/0194599814529080. Epub 2014 Apr 4.
Pressure equalization tube (PET) placement is the most common surgical procedure performed during childhood. Current guidelines recommend more prompt management of children with otitis media with effusion who are at greater risk for speech-language and developmental problems. This study was designed to examine risk factors for continued post-PET hearing loss in a large pediatric clinical sample.
Retrospective analysis using the electronic medical record.
Tertiary care children's hospital.
Pediatric patients undergoing PET placement between January 2009 and October 2012 who had audiometric tests.
Demographics, patient diagnoses, and hearing loss information were extracted. Multivariate binary logistic regression models were used to identify associations between patient-specific characteristics and the presence of hearing loss.
In total, 3949 children with 4598 audiology visits were included (2357 males and 1592 females; mean age, 3.3 years), and 1272 preoperative and 3329 postoperative audiograms were performed. Using multivariate modeling, the only variable significantly associated with preoperative hearing loss was low tympanometric static acoustic admittance. Postoperative hearing loss was positively associated with patient age, preoperative hearing loss, lower tympanometric equivalent canal volumes, and Down syndrome. Other factors, including cranial/facial anomalies, low birth weight or prematurity, allergies, and asthma, were not determined to be risk factors for hearing loss.
Our results support hearing testing to identify candidates for PET surgery and to determine treatment effectiveness after surgery, since hearing loss cannot be predicted on the basis of risk or demographic factors. These data have important preoperative counseling and postoperative management implications.
放置压力平衡管（PET）是儿童期最常见的外科手术。当前指南建议对有更大言语和发育问题风险的中耳积液患儿进行更及时的治疗。本研究旨在调查一大组儿科临床样本中PET置入术后持续听力损失的危险因素。
使用电子病历进行回顾性分析。
三级护理儿童医院。
2009年1月至2012年10月期间接受PET置入术并进行听力测试的儿科患者。
提取人口统计学、患者诊断和听力损失信息。使用多变量二元逻辑回归模型确定患者特定特征与听力损失之间的关联。
总共纳入了3949名儿童，进行了4598次听力检查（男性2357名，女性1592名；平均年龄3.3岁），并进行了1272次术前和3329次术后听力图检查。通过多变量建模，与术前听力损失显著相关的唯一变量是鼓室图静态声导纳低。术后听力损失与患者年龄、术前听力损失、较低的鼓室图等效耳道容积和唐氏综合征呈正相关。其他因素，包括颅面畸形、低出生体重或早产、过敏和哮喘，未被确定为听力损失的危险因素。
我们的结果支持进行听力测试，以确定PET手术的候选者并确定术后治疗效果，因为听力损失无法根据风险或人口统计学因素预测。这些数据对术前咨询和术后管理具有重要意义。
