Lavere Philip F, Ohlstein Jason F, Smith Steven P, Szeremeta Wasyl, Pine Harold S
University of Texas Medical Branch Department of Otolaryngology, 7.104 John Sealy Annex, 301 University Boulevard, Galveston, TX, 77555, USA.
University of Texas Medical Branch Department of Otolaryngology, 7.104 John Sealy Annex, 301 University Boulevard, Galveston, TX, 77555, USA. Electronic address: https://www.utmb.edu/oto/.
Int J Pediatr Otorhinolaryngol. 2019 Jul;122:40-43. doi: 10.1016/j.ijporl.2019.03.031. Epub 2019 Mar 28.
In 2013 the American Academy of Otolaryngology published tympanostomy tube guidelines for children; Action Statement 6 recommends against tube placement without middle ear effusion (MEE) at time of assessment. To date, little research has directly evaluated this recommendation in reducing the need for ear tubes. We evaluated the effectiveness of this recommendation and potential risk factors that influence the success of watchful waiting.
Retrospective chart review collecting demographics, daycare status, smoking exposure, and time of year of visit. Children aged 6 months to 12 years without MEE on presentation, but with 3 or more episodes of acute otitis media (AOM) in 6 months or 4 or more episodes in 12 months, were assigned to watchful waiting (WW) treatment. These patients were followed every 4 months or returned sooner with additional infections. Any continued AOM, or MEE on follow up leading to tube placement, defined WW failure.
123 patients met criteria, with 81 still in WW to date (66% success rate). 42 children failed WW and received tympanostomy tubes (34% failure rate). There were no statistically significant associations between age, race, gender, smoking exposure, daycare, or month of presentation between children who failed WW compared to children receiving tubes.
Tympanostomy tube guidelines mitigate unnecessary tube placement in a majority of children with recurrent AOM without MEE. To our knowledge, this is the first study supporting the 2013 recommendations, with a 66% success rate. Additionally, no significant associations between modifying risk factors in those who failed watchful waiting were identified.
2013年美国耳鼻咽喉头颈外科学会发布了儿童鼓膜置管指南；行动声明6建议在评估时中耳无积液（MEE）的情况下不进行置管。迄今为止，几乎没有研究直接评估这一建议对减少耳管需求的作用。我们评估了这一建议的有效性以及影响观察等待成功的潜在风险因素。
回顾性病历审查，收集人口统计学资料、日托情况、吸烟暴露情况和就诊时间。6个月至12岁、就诊时无中耳积液但在6个月内有3次或更多次急性中耳炎（AOM）发作或在12个月内有4次或更多次发作的儿童，被分配接受观察等待（WW）治疗。这些患者每4个月随访一次，或因再次感染提前复诊。任何持续的AOM或随访时出现中耳积液并导致置管，定义为WW失败。
123例患者符合标准，迄今为止81例仍在接受WW治疗（成功率66%）。42例儿童WW失败并接受了鼓膜置管（失败率34%）。与接受置管的儿童相比，WW失败的儿童在年龄、种族、性别、吸烟暴露、日托或就诊月份方面没有统计学上的显著关联。
鼓膜置管指南减少了大多数无中耳积液的复发性AOM儿童不必要的置管。据我们所知，这是第一项支持2013年建议的研究，成功率为66%。此外，未发现观察等待失败的患者中危险因素改变之间存在显著关联。
