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Original Investigation |

Perioperative Hearing Evaluations for Patients Undergoing Tympanostomy Tube Placement ONLINE FIRST

Kenneth R. Whittemore Jr, MD, MSc1,2; Briana K. Dornan, AuD, CCC-A1; Jenna M. Dargie, BS1; Guangwei Zhou, ScD1
[+] Author Affiliations
1Boston Children’s Hospital, Department of Otolaryngology and Communication Enhancement, Boston, Massachusetts
2Harvard Medical School, Department of Otology and Laryngology, Boston, Massachusetts
JAMA Otolaryngol Head Neck Surg. Published online August 04, 2016. doi:10.1001/jamaoto.2016.1980
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Importance  Obtaining hearing thresholds is an important step in the evaluation of a child with otitis media because decreased hearing in the presence of a chronic middle ear effusion factors into the decision to place tympanostomy tubes (TTs).

Objective  To provide evidence regarding appropriate use of perioperative hearing evaluations in conjunction with TTs.

Design, Setting, and Participants  Case series with medical record review of all patients aged 0 to 24 years who received TTs at a tertiary pediatric care facility from June 1, 2010, through June 1, 2011. Medical records were abstracted by 1 researcher for surgical, audiometric, tympanometric, clinical, and patient demographic data. The data analysis was performed between December 1, 2014, and June 1, 2015.

Main Outcomes and Measures  Audiometric data were examined to determine the number of patients with hearing loss preoperatively and postoperatively, with the intention to describe the population with no prior hypothesis regarding results.

Results  Of 2274 patients identified, 910 (40.0%) were female. Median (interquartile range) age at TT placement was 2.62 (1.48-4.94) years. A total of 1757 (77.3%) underwent audiometric evaluation preoperatively, 1742 (76.6%) postoperatively, and 1395 (61.3%) both preoperatively and postoperatively; 170 (7.5%) had no audiometric testing. Within 1 year after surgery, 271 (11.9%) of patients had evidence of nonfunctional tubes. Postoperatively, 19.9% (347 of the 1742 patients who received a postoperative evaluation) had hearing loss. In all, 89 (3.9%) patients had a permanent sensorineural hearing loss, and 15 (0.66%) had a persistent conductive hearing loss.

Conclusions and Relevance  A postoperative audiometric examination should be performed in children who have hearing loss when evaluated before TT placement to determine whether resolution of the hearing loss was obtained.

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Figure.
Preoperative and Postoperative Hearing Results

Preoperative and postoperative hearing results for patients who received tympanostomy tubes within a 1-year period at a pediatric tertiary care facility. Tympanostomy tubes were deemed nonfunctional if any reading other than large volumes was obtained. HL indicates hearing level.

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