Bezdjian Aren, Jiang Joanna, Maby Alexandra, Daniel Sam J
Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada; McGill Auditory Sciences Laboratory, McGill University Health Centre, Montreal, Quebec, Canada.
McGill Auditory Sciences Laboratory, McGill University Health Centre, Montreal, Quebec, Canada; Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada.
Int J Pediatr Otorhinolaryngol. 2018 Jan;104:220-223. doi: 10.1016/j.ijporl.2017.11.023. Epub 2017 Nov 22.
Tympanostomy tube placement is the most common surgical procedure performed in children. Medial migration of a tympanostomy tube is a rare occurrence where the tube migrates into the middle ear cavity as opposed to its normal extrusion into the external auditory canal. Whether medialized tympanostomy tubes should be surgically removed in asymptomatic patients is controversial. The objective of this study was to determine experience and management approach of medialized tympanostomy tubes among pediatric otolaryngologists.
A 12-question cross-section survey was designed and distributed to the American Society of Pediatric Otolaryngology (ASPO) members. The survey study was granted McGill University institutional review board and ASPO research committee approval. The survey data were filtered and cross-tabulated. Descriptive statistics were generated.
128 pediatric otolaryngologists completed the 12-question survey. The majority of respondents had experienced at least one case of medialized tympanostomy tube (90.6%). The majority of patients (82.0%) were asymptomatic. 74 out of 128 respondents (57.8%) indicated that they would not remove a medialized tube in an asymptomatic patient. However, 7.0% of those respondents clarified that they would proceed to surgical removal if the patient were undergoing general anesthesia for another surgery. 30.5% of respondents indicated that they would surgically remove the tube even if the patient were asymptomatic. 6.3% of respondents indicated that opted management in children would be based on a shared decision with parents. Most respondents (80.5%) did not experience complications with surgical removal nor with elected observation.
There is no consensus among pediatric otolaryngologists regarding the necessity of surgically removing a medialized tympanostomy tube in asymptomatic patients. The survey suggests that both options are acceptable. If observation is chosen, it is important that parents are well informed of the potential long-term sequelae of a medialized tube and advised to consult if symptoms occur.
鼓膜置管术是儿童中最常见的外科手术。鼓膜置管向内侧迁移是一种罕见情况，即置管迁移至中耳腔，而非正常向外耳道挤出。对于无症状患者，是否应通过手术取出向内侧移位的鼓膜置管存在争议。本研究的目的是确定儿科耳鼻喉科医生处理向内侧移位鼓膜置管的经验和管理方法。
设计了一份包含12个问题的横断面调查问卷，并分发给美国儿科耳鼻喉科协会（ASPO）成员。该调查研究获得了麦吉尔大学机构审查委员会和ASPO研究委员会的批准。对调查数据进行筛选和交叉制表，并生成描述性统计数据。
128名儿科耳鼻喉科医生完成了这份包含12个问题的调查问卷。大多数受访者（90.6%）至少遇到过一例鼓膜置管向内侧迁移的病例。大多数患者（82.0%）无症状。128名受访者中有74名（57.8%）表示，他们不会在无症状患者中取出向内侧移位的置管。然而，这些受访者中有7.0%明确表示，如果患者因另一次手术接受全身麻醉，他们会进行手术取出。30.5%的受访者表示，即使患者无症状，他们也会通过手术取出置管。6.3%的受访者表示，对儿童的选择管理将基于与家长的共同决策。大多数受访者（80.5%）在手术取出或选择观察时均未遇到并发症。
儿科耳鼻喉科医生对于无症状患者是否有必要通过手术取出向内侧移位的鼓膜置管尚未达成共识。调查表明，两种选择都是可以接受的。如果选择观察，重要的是要让家长充分了解向内侧移位置管的潜在长期后遗症，并建议他们在出现症状时咨询医生。
