Does tympanostomy tube placement affect vestibular function in young children?
Background: One of the most common questions we are asked as otolaryngologists is whether placement of ventilation tubes will help a child who has otitis media with an effusion (OME). OME is defined as the presence of a middle-ear effusion with signs or symptoms of an acute infection. Although, anecdotally, balance seems to improve after bilateral myringotomy and tube insertion (BMT), the existing evidence is fairly limited.
Explore this issue:
December 2011Study design: Prospective case-control study.
Setting: Tertiary care academic hospital.
Synopsis: A cohort of 72 patients (mean age=69 months) with OME and 56 control patients (mean age=72 months) underwent rotational chair testing (RCT) and computerized dynamic posturography (CDP). The OME cohort then underwent BMT, followed by RCT and CDP testing, at one, three and six months post-operatively. The control cohort underwent RCT and CDP testing at the same intervals.
No difference was seen between the two cohorts on RCT outcomes or sensory organization testing scores. Higher sway velocity during CDP was observed in the BMT cohort, both pre-operatively and at one month post-operatively, although these differences were not statistically significant. At six months, the BMT cohort had a statistically significant decrease in sway velocity compared with the control group.
The limitation of this study is the inability to get complete data sets on each patient. Also, the authors admit that it is difficult to reliably obtain data from this cohort of patients due to their young age and testing fatigue. Despite these limitations, the results are intriguing and are congruent with previous studies on this topic.
Bottom line: This study was able to find small differences in vestibular function in patients before and after BMT. Therefore, in addition to questioning the parents of OME patients about hearing and speech development, we should also question them about balance development.
Citation: Cohen MS, Mandel EM, Furman JM, et al. Tympanostomy tube placement and vestibular function in children. Otolaryngol Head Neck Surg. 2011;145(4):666-672.
—Reviewed by Ravindhra G. Elluru, MD, PhD