Children's Mercy Hospital, Department of Surgery, Attention ENT, 2401 Gillham Rd, Kansas City, MO, 64014, USA; University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, 53792, USA.
Int J Pediatr Otorhinolaryngol. 2024 Nov;186:112118. doi: 10.1016/j.ijporl.2024.112118. Epub 2024 Sep 25.
To characterize medical complexity and advanced interventions necessary to treat pediatric patients with chronic ear disease.
A retrospective case review of children who received surgery for chronic otitis media, cholesteatoma, or tympanic membrane perforation at a tertiary children's hospital from 2020 to 2024 was performed. The frequency and type of medical complexities as well as distribution and success of advanced otologic interventions were recorded.
Operations were performed on 80 ears. Forty-five percent were in medically complex patients. Twenty-five percent had a syndrome, 13 % had American Society for Anesthesiologists Severity Class 3 or more, and 38 % attended multi-disciplinary programs. Advanced audiology testing protocols were utilized in 53 % of patients, and multiple children received complex sleep and airway operations. Advanced surgical techniques were required in 58 %. Post-operatively, an intact tympanic membrane was achieved in 95 % of operated ears (p < 0.01). Residual and recurrent cholesteatoma were each present in 5 % of cases, with mean follow-up of 11.6 months. Otorrhea reduced from 64 % of patients pre-operatively to 2 % post-operatively (p < 0.01), including cessation in all individuals who reported social/bullying issues related to ear drainage/odor. Unrestricted water exposure was achieved in 99 % of individuals (p < 0.01). Patients showed a mean improvement after surgery of 7.6 dB, as measured by the change in air-bone gap (p < 0.05).
Comprehensive treatment of otologic conditions included care that was holistic of all medical needs, integrated with other services, developmentally appropriate, encompassing of non-otologic procedures, technically advanced, effective, and functionally-focused. Surgical teams should endeavor together to provide this combination of services.
描述治疗患有慢性耳部疾病的儿科患者所需的医疗复杂性和高级干预措施。
对 2020 年至 2024 年在一家三级儿童医院接受慢性中耳炎、胆脂瘤或鼓膜穿孔手术的儿童进行回顾性病例回顾。记录医疗复杂性的频率和类型，以及高级耳科干预措施的分布和成功率。
对 80 只耳朵进行了手术。45%的患者为医疗复杂患者。25%的患者患有综合征，13%的患者美国麻醉医师协会严重程度分类为 3 级或更高级别，38%的患者参加了多学科项目。53%的患者采用了高级听力学测试方案，多名儿童接受了复杂的睡眠和气道手术。58%的患者需要采用高级手术技术。术后，95%的手术耳鼓膜完整（p<0.01）。残留和复发性胆脂瘤各占 5%，平均随访 11.6 个月。术前有 64%的患者存在耳漏，术后降至 2%（p<0.01），包括所有报告与耳部引流/气味相关的社交/欺凌问题的患者。99%的患者可不受限制地接触水（p<0.01）。患者手术后平均听力改善 7.6dB，气骨导差减小（p<0.05）。
全面的耳部疾病治疗包括对所有医疗需求的全面关怀，与其他服务相结合，适合发育阶段，包括非耳部手术，技术先进，有效且注重功能。手术团队应共同努力提供这种服务组合。
