Surgery for Otitis Media with Effusion: A Survey of Otolaryngologists Who Treat Children in Brazil

Nobrega, Manoel de; Carvalho, Daniela; Lubianca Neto, José Faibes

doi:10.1055/s-0042-1742324

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International Archives of Otorhinolaryngology

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Original Research • iao 27 (2) • Apr 2023 • https://doi.org/10.1055/s-0042-1742324 copy

Surgery for Otitis Media with Effusion: A Survey of Otolaryngologists Who Treat Children in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Myringotomy and ear tube placement (MTP) is the surgical treatment for otitis media with effusion (OME), and it is the most common surgery performed in children. Several guidelines have been developed to assist in the care of patients who become candidates for MTP.

Objectives

To evaluate the practice of Brazilian otorhinolarynogologists when performing MTP according to the years of clinical experience. Secondarily, we also want to assess if their practice regarding MTP varied according to the percentage of children treated and the location of their practice.

Methods

A 30-question survey was sent to otolaryngologists affiliated with the Brazilian Academy of Pediatric Otorhinolaryngology (Academia Brasileira de Otorrinolaringologia Pediátrica, ABOPe, in Portuguese) and/or the Scientific Department of Otorhinolaryngology of the Brazilian Society of Pediatrics (Sociedade Brasileira de Pediatria, SBP, in Portuguese). The questions included were carefully chosen to provide a profile about the practices adopted in the pre-, peri- and postoperative periods of MTP.

Results

The questionnaire was sent to 208 otolaryngologists, and there were 124 (59.6%) respondents. Of those, 59.7% use antiseptics before surgery. Only 54 otolaryngologists, less than half of the subjects in this study (43.5%), always place a tube during the procedure. More physicians who practice in small cities recommend water precautions after MTP when compared to other physicians (p < 0.001).

Conclusions

The present study reveals that many respondents do not follow some of the recommendations of the current guidelines of the American Academy of

Keywords
otitis media with effusion; tympanostomy tube insertion; children; survey

Variable	n	%
Procedure
ALWAYS places the ventilation tube	54	43.5
NEVER places the ventilation tube	1	0.8
Only places the ventilation tube if secretion comes out of the paracentesis	19	15.3
Only places the ventilation tube if one can aspirate secretion through the paracentesis	33	26.6
Only places the ventilation tube if the tympanic membrane is flaccid	1	0.8
Other	16	12.9
Prescription of antibiotics in the postoperative period
No	90	72.6
Yes	34	27.4
Guidelines
Protection with cotton soaked in oil	55	44.4
Silicone plugs	28	22.6
Custom-molded ear protectors made in companies that work with hearing aids	52	41.9
Prohibition against swimming	46	37.1
Prohibition against diving	70	56.5
Prohibition against immersing in sea water	44	35.5
Does not indicate specific protection	14	11.3
Other	3	2.4
Type of ventilation tube for patients without comorbidities
Sheppard	84	67.7
Paparella	6	4.8
Armstrong	1	0.8
Donaldson	32	25.8
Other	1	0.8
Type of ventilation tube for syndromic patients and those with other comorbidities
Sheppard	27	21.8
Paparella	48	38.7
Armstrong	4	3.2
Donaldson	17	13.7
T tube	21	16.9
Other	7	5.6
Surgical technique
Surgical microscope	90	72.6
Endoscope	13	10.5
Both	21	16.9

Variable	Classification	n	%
Years of practice	Fewer than 10 years	55	44.4
	10 to 20 years	31	25.0
	20 to 30 years	19	15.3
	More than 30 years	19	15.3
Percentage of pediatric patients	Up to 25%	13	10.5
	25 to 50%	47	37.9
	50 to 75%	50	40.3
	100%	14	11.3
Location of the practice	Large city	84	67.7
	Countryside	29	23.4
	Coastal city	11	8.9

	Years of practice								p-value
	Fewer than 10 years (n = 55)		10 to 20 years (n = 31)		20 to 30 years (n = 19)		More than 30 years (n = 19)
Variable	n	%	n	%	n	%	n	%
Use of ventilation tube
ALWAYS places a ventilation tube	25	45.5	16	51.6	7	36.8	6	31.6	0.709⁽¹⁾
Only places the ventilation tube if the tympanic membrane is flaccid	0	0.0	1	3.2	0	0.0	0	0.0
Only places the ventilation tube if secretion comes out through the myringotomy	9	16.4	3	9.7	3	15.8	4	21.1
Only places the ventilation tube if one can suction secretion through the myringotomy	16	29.1	6	19.4	6	31.6	5	26.3
NEVER places a ventilation tube	0	0.0	0	0.0	0	0.0	1	5.3
Other	5	9.1	5	16.1	3	15.8	3	15.8
Do you prescribe systemic antibiotics in the postoperative period?
No	38	69.1	20	64.5	16	84.2	16	84.2	0.273⁽²⁾
Yes	17	30.9	11	35.5	3	15.8	3	15.8	0.273⁽²⁾
Guidelines
	30	54.5	10	32.3	5	26.3	10	52.6	0.066⁽²⁾
Protection with cotton soaked in oil
Silicone ear plugs	10	18.2	3	9.7	5	26.3	10	52.6	0.005⁽¹⁾
Custom-molded ear plugs	17	30.9	11	35.5	11	57.9	13	68.4	0.013⁽²⁾
Does not allow swimming	20	36.4	14	45.2	7	36.8	5	26.3	0.610(2)
Does not allow diving	35	63.6	20	64.5	7	36.8	8	42.1	0.088(2)
Does not allow immersion in sea water	20	36.4	15	48.4	6	31.6	3	15.8	0.132(2)
No water precautions indicated	8	14.5	2	6.5	4	21.1	0	0.0	0.112(1)
Other	2	3.6	0	0.0	1	5.3	0	0.0	0.643(1)
Type of ventilation tube for patients without comorbidities
Armstrong	0	0.0	1	3.2	0	0.0	0	0.0	0.549⁽¹⁾
Donaldson	18	32.7	6	19.4	4	21.1	4	21.1
Other	1	1.8	0	0.0	0	0.0	0	0.0
Paparella	3	5.5	0	0.0	2	10.5	1	5.3
Sheppard	33	60.0	24	77.4	13	68.4	14	73.7
Type of ventilation tube for syndromic patients and those with other comorbidities
Armstrong	0	0.0	1	3.2	2	10.5	1	5.3	0.229⁽¹⁾
Donaldson	10	18.2	4	12.9	3	15.8	0	0.0
Other	4	7.3	2	6.5	0	0.0	1	5.3
Paparella	20	36.4	8	25.8	9	47.4	11	57.9
Sheppard	12	21.8	10	32.3	3	15.8	2	10.5
T tube	9	16.4	6	19.4	2	10.5	4	21.1
What surgical technique do you use?
Both	10	18.2	7	22.6	3	15.8	1	5.3	0.110⁽¹⁾
Endoscope	9	16.4	4	12.9	0	0.0	0	0.0
Surgical microscope	36	65.5	20	64.5	16	84.2	18	94.7

	Percentage of pediatric patients								p-value
	Up to 25% (n = 13)		25% to 50% (n = 47)		50% to 75% (n = 50)		100% (n = 14)
Variable	n	%	n	%	n	%	n	%
Use of ventilation tube
ALWAYS places the ventilation tube	4	30.8	17	36.2	22	44.0	11	78.6	0.097⁽¹⁾
Only places the ventilation tube if secretion comes out through the myringotomy	0	0.0	0	0.0	1	2.0	0	0.0
Only places the ventilation tube if one can suction secretion through the myringotomy	3	23.1	11	23.4	5	10.0	0	0.0
NEVER places a ventilation tube	6	46.2	13	27.7	13	26.0	1	7.1
Only places the ventilation tube if secretion comes out through the myringotomy	0	0.0	0	0.0	1	2.0	0	0.0
Other	0	0.0	6	12.8	8	16.0	2	14.3
Do you prescribe systemic antibiotics in the postoperative period?
No	7	53.8	30	63.8	39	78.0	14	100.0	0.010⁽¹⁾
Yes	6	46.2	17	36.2	11	22.0	0	0.0	0.010⁽¹⁾
Guidelines
Protection with cotton soaked in oil	5	38.5	27	57.4	23	46.0	0	0.0	0.002⁽²⁾
Silicone ear plugs	4	30.8	13	27.7	9	18.0	2	14.3	0.523⁽¹⁾
Custom-molded ear plugs	8	61.5	17	36.2	18	36.0	9	64.3	0.098⁽²⁾
Does not allow swimming	6	46.2	22	46.8	17	34.0	1	7.1	0.047⁽²⁾
Does not allow diving	8	61.5	33	70.2	27	54.0	2	14.3	0.003⁽²⁾
Does not allow immersion in sea water	6	46.2	22	46.8	14	28.0	2	14.3	0.063⁽¹⁾
No water precautions indicated	0	0.0	4	8.5	7	14.0	3	21.4	0.283⁽¹⁾
Other	0	0.0	1	2.1	2	4.0	0	0.0	1.000⁽¹⁾
Type of ventilation tube for patients without comorbidities
Armstrong	0	0.0	0	0.0	0	0.0	1	7.1	0.352⁽¹⁾
Donaldson	2	15.4	11	23.4	13	26.0	6	42.9
Other	0	0.0	1	2.1	0	0.0	0	0.0
Paparella	0	0.0	3	6.4	2	4.0	1	7.1
Sheppard	11	84.6	32	68.1	35	70.0	6	42.9
Type of ventilation tube for syndromic patients and those with other comorbidities
Armstrong	1	7.7	1	2.1	1	2.0	1	7.1	0.544⁽¹⁾
Donaldson	2	15.4	7	14.9	6	12.0	2	14.3
Other	1	7.7	2	4.3	4	8.0	0	0.0
Paparella	2	15.4	19	40.4	20	40.0	7	50.0
Sheppard	3	23.1	8	17.0	12	24.0	4	28.6
T tube	4	30.8	10	21.3	7	14.0	0	0.0
Both	1	7.7	7	14.9	12	24.0	1	7.1	0.172⁽¹⁾
Endoscope	1	7.7	9	19.1	3	6.0	0	0.0
Surgical microscope	11	84.6	31	66.0	35	70.0	13	92.9

	Location of the practice						p-value
	Large city (n = 84)		Countryside (n = 29)		Coastal city (n = 11)
	n	%	n	%	n	%
Use of ventilation tube
ALWAYS places the ventilation tube	35	41.7	16	55.2	3	27.3	0.463⁽²⁾
Only places the ventilation tube if the tympanic membrane is flaccid	0	0.0	1	3.4	0	0.0
Only places the ventilation tube if secretion comes out by the paracentesis	12	14.3	5	17.2	2	18.2
Only places the ventilation tube if one can suction secretion through the paracentesis	25	29.8	4	13.8	4	36.4
NEVER places the ventilation tube	1	1.2	0	0.0	0	0.0
Other	11	13.1	3	10.3	2	18.2
Do you prescribe systemic antibiotics in the postoperative period?
No	61	72.6	20	69.0	9	81.8	0.811⁽²⁾
Yes	23	27.4	9	31.0	2	18.2	0.811⁽²⁾
Guidelines
Protection with cotton soaked in oil	31	36.9	21	72.4	3	27.3	0.002⁽¹⁾
Silicone ear plugs	17	20.2	10	34.5	1	9.1	0.153⁽¹⁾
Custom-molded ear plugs	39	46.4	9	31.0	4	36.4	0.324⁽¹⁾
Does not allow swimming	31	36.9	11	37.9	4	36.4	0.994⁽¹⁾
Does not allow diving	45	53.6	18	62.1	7	63.6	0.642⁽¹⁾
Does not allow immersion in sea water	30	35.7	10	34.5	4	36.4	0.991⁽¹⁾
No water precautions indicated	9	10.7	3	10.3	2	18.2	0.733⁽²⁾
Other	1	1.2	1	3.4	1	9.1	0.133⁽²⁾
Type of ventilation tube for patients without comorbidities
Armstrong	1	1.2	0	0.0	0	0.0	0.039⁽²⁾
Donaldson	27	32.1	2	6.9	3	27.3
Other	1	1.2	0	0.0	0	0.0
Paparella	5	6.0	0	0.0	1	9.1
Sheppard	50	59.5	27	93.1	7	63.6
Type of ventilation tube for syndromic patients and those with other comorbidities
Armstrong	4	4.8	0	0.0	0	0.0	0.058⁽²⁾
Donaldson	14	16.7	1	3.4	2	18.2
Other	3	3.6	1	3.4	3	27.3
Paparella	31	36.9	13	44.8	4	36.4
Sheppard	17	20.2	10	34.5	0	0.0
T tube	15	17.9	4	13.8	2	18.2
What surgical technique do you use?
Both	13	15.5	7	24.1	1	9.1	0.451⁽²⁾
Endoscope	10	11.9	1	3.4	2	18.2
Surgical microscope	61	72.6	21	72.4	8	72.7

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[1] Address for correspondence Manoel de Nobrega, MD, PhD, Department of Otorhinolaryngology, Federal University of São Paulo, Rua Coronel Lisboa, 856, Vila Clementino, São Paulo, São Paulo, Brazil CEP 04020-040 (e-mail: mnobrega@terra.com.br).