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The use of transient evoked otoacoustic emissions as a hearing screen following grommet insertion

Conclusion: Transient evoked otoacoustic emission testing offers a sensitive means of detecting hearing loss of ≥30 dB following grommet insertion in children. However, the use of such testing as a screening tool may miss some cases of mild hearing loss.

from the Journal of Laryngology and Otology

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Cochrane Review Cochrane review: Grommets (ventilation tubes) for recurrent acute otitis media in children

Main results
Two studies involving 148 children were included in the review. One of these studies, involving 95 children, showed that ventilation tube insertion leads to a mean reduction of 1.5 episodes of acute otitis media in the first six months after treatment. This study also showed a significant increase in the proportion of children with no episodes of AOM (p < 0.001) in the ventilation tube group. The other included study also found a higher proportion of patients in the ventilation tube group had no episodes of AOM in the six months after intervention, but the difference did not reach statistical significance (p = 0.16).

Authors' conclusions
Ventilation tubes have a significant role in maintaining a 'disease-free' state in the first six months after insertion. Further research is required to investigate the effect beyond six months. Clinicians should consider the possible adverse effects of grommet insertion before surgery is undertaken.

Plain Language Summary
Grommets (ventilation tubes) for recurrent acute otitis media in children
Acute otitis media is a common disease of childhood, involving inflammation of the space behind the eardrum (the middle ear cleft). Episodes typically involve a fever and a build up of pus that stretches the eardrum causing severe pain. The drum may then rupture, relieving the pain, and a discharge of pus enters the ear canal. A small proportion of children suffer with recurrent acute otitis media, which is defined as either three or more acute infections of the middle ear cleft in a six-month period, or at least four episodes in a year.
One of the strategies used to treat this condition is the insertion of a miniature plastic ventilation tube (or grommet) into the eardrum, which prevents the painful accumulation of pus in the middle ear. This review aims to assess the evidence for the effectiveness of this treatment in reducing recurrent acute otitis media.
We searched for scientific studies which compared treating children with recurrent acute otitis media with either grommets or a non-surgical treatment such as antibiotics (or no treatment). In these studies, children with ventilation tubes in place were considered to have suffered an episode of acute otitis media if they had a discharge of pus from the ear.
Five suitable studies were found. The studies were assessed for scientific quality, and two were found to be suitable for further analysis. The combined results from these two studies suggested that more children treated with ventilation tubes are rendered symptom free in the six months following surgery compared to those who received other treatments or no treatment. One of the 2 included studies involving 95 children showed that ventilation tubes reduce the number of episodes of acute otitis media in the first six months after surgery, by an average of 1.5 episodes per child.
When considering the size of this effect, it is important to bear in mind that the studies were not perfect in their design and execution. To be confident in these findings further high-quality research is required.

from Evidence-Based Child Health

Middle ear disease in children with cleft palate: Protocols for management

Objective
There is wide international variation in the protocols used for middle ear disease management in cleft palate patients. Ventilation tube (grommet) insertion may occur routinely at the time of palatoplasty or selectively on a separate occasion if symptomatic middle ear disease develops. The audiological and otologic outcomes of cleft palate patients were studied in a single institution over a timeframe in which both protocols were utilised.

Methods
This was a retrospective study of 234 cleft palate patients who underwent palatoplasty from 1990 to 2005 at Middlemore Hospital, Auckland, New Zealand. Data on hearing loss, middle ear disease, and tympanic membrane abnormalities was collected from clinical notes. Audiological data was obtained from pure tone audiogram reports.

Results
Forty-five patients had routine grommets inserted concurrent with palatoplasty and 189 patients were managed conservatively with selective grommet insertion if indicated. Grommets were subsequently required in 79 (41.8%) of these 189 patients. There was no difference in the incidence of persistent conductive hearing loss, but recurrent middle ear disease, tympanic membrane abnormalities, and the total number of grommet insertions were significantly higher in the routine grommet group. Poorer outcomes were noted in patients who had undergone a greater number of grommet insertions.

Conclusion
No significant deterioration in audiological outcomes and better otologic outcomes were found in cleft palate patients undergoing selective grommet insertion compared to routine grommet insertion. It is recommended that ventilation tube placement occur in patients selected on the basis of symptomatic infection or significant hearing loss.

from the International Journal of Pediatric Otorhinolaryngology