RESUMEN
Abstract Introduction Myringotomy for tube insertion is the most common otologic surgery. Otorrhea is a frequent complication of this procedure and, to prevent it, most surgeons strongly recommend avoiding contact with water as this is thought to adversely impact on post-operative quality of life. Objective To understand the benefit of this recommendation. Methods Observational study - retrospective cohort study comparing the incidence of post-operative otorrhea and its impact on patients' quality of life, in two groups of patients comprising children under 10 years of age who underwent bilateral myringotomy and tube placement for chronic otitis media with effusion between May 2011 and May 2012. One group received water protection care after surgery, the other did not. Data was collected through telephonic interview, after one year of follow up (one year after the procedure). Water exposure without protection was considered the exposure event. Incidence of otorrhea and perceived impact on quality of life were the outcome measures. Results were compared after logistic regression. Results We included 143 children: 116 were not exposed to water without protection and 27 were exposed. In the not exposed group 36.2% had at least one episode of otorrhea, compared to 40.0% of the exposed group. Odds ratio for otorrhea on exposed was 1.21 (95% CI 0.51-2.85, p = 0.6). Negative impact on quality of life was reported by parents of 48.2% on the not exposed children, compared to 40.7% on the exposed group. This difference was not significant (p = 0.5). Conclusion We found that recommending water protection did not have beneficial effect on the incidence of otorrhea after myringotomy with tubes on chronic otitis media with effusion. However, such measures did not appear to have a negative impact on quality of life. This is a populational observational study with few cases (143 cases); these final statements would be better stated by a very large populational study with another large control group.
Resumo Introdução A miringotomia para inserção de tubo de ventilação é a cirurgia otológica mais comum. Otorreia é uma complicação frequente deste procedimento e, para evita-la, a maioria dos cirurgiões recomenda evitar o contato com a água, pois acredita-se que isso possa afetar negativamente a qualidade de vida pós-operatória. Objetivo Verificar o benefício dessa recomendação. Método Estudo observacional - estudo de coorte retrospectivo, comparando a incidência de otorreia pós-operatória e seu impacto na qualidade de vida dos pacientes, em dois grupos de pacientes com crianças menores de 10 anos submetidas à miringotomia bilateral e colocação de tubo de ventilação para o tratamento de otite média crônica com efusão, entre maio de 2011 e maio de 2012. Um grupo recebeu cuidados de proteção contra a água após a cirurgia, o outro não. Os dados foram coletados através de entrevista telefônica, após um ano de seguimento (um ano após o procedimento). A exposição à água sem proteção foi considerada o evento de exposição. A incidência de otorreia e o impacto percebido na qualidade de vida foram as medidas de resultado. Os resultados foram comparados após a regressão logística. Resultados Incluímos 143 crianças: 116 não foram expostas à água sem proteção e 27 foram expostas. No grupo não exposto, 36,2% apresentaram pelo menos um episódio de otorreia, em comparação com 40,0% do grupo exposto. A razão de chances (odds ratio) para otorreia no grupo exposto foi de 1,21 (IC 95%: 0,51-2,85, p = 0,6). O impacto negativo na qualidade de vida foi relatado pelos pais de 48,2% nas crianças não expostas, em comparação com 40,7% no grupo exposto. Essa diferença não foi significante (p = 0,5). Conclusão Não verificamos um efeito benéfico sobre a incidência de otorreia ao recomendar a proteção contra a água após colocação de tubos de ventilação para otite média com efusão. Entretanto, tais medidas não parecem ter tido um impacto negativo na qualidade de vida.
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Otitis Media Supurativa/etiología , Otitis Media Supurativa/prevención & control , Complicaciones Posoperatorias/prevención & control , Otitis Media con Derrame/cirugía , Agua , Ventilación del Oído Medio/efectos adversos , Otitis Media Supurativa/epidemiología , Portugal/epidemiología , Complicaciones Posoperatorias/epidemiología , Calidad de Vida , Modelos Logísticos , Incidencia , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Oído Medio/metabolismo , Prevención SecundariaRESUMEN
INTRODUCTION: Myringotomy for tube insertion is the most common otologic surgery. Otorrhea is a frequent complication of this procedure and, to prevent it, most surgeons strongly recommend avoiding contact with water as this is thought to adversely impact on post-operative quality of life. OBJECTIVE: To understand the benefit of this recommendation. METHODS: Observational study - retrospective cohort study comparing the incidence of post-operative otorrhea and its impact on patients' quality of life, in two groups of patients comprising children under 10 years of age who underwent bilateral myringotomy and tube placement for chronic otitis media with effusion between May 2011 and May 2012. One group received water protection care after surgery, the other did not. Data was collected through telephonic interview, after one year of follow up (one year after the procedure). Water exposure without protection was considered the exposure event. Incidence of otorrhea and perceived impact on quality of life were the outcome measures. Results were compared after logistic regression. RESULTS: We included 143 children: 116 were not exposed to water without protection and 27 were exposed. In the not exposed group 36.2% had at least one episode of otorrhea, compared to 40.0% of the exposed group. Odds ratio for otorrhea on exposed was 1.21 (95% CI 0.51-2.85, p=0.6). Negative impact on quality of life was reported by parents of 48.2% on the not exposed children, compared to 40.7% on the exposed group. This difference was not significant (p=0.5). CONCLUSION: We found that recommending water protection did not have beneficial effect on the incidence of otorrhea after myringotomy with tubes on chronic otitis media with effusion. However, such measures did not appear to have a negative impact on quality of life. This is a populational observational study with few cases (143 cases); these final statements would be better stated by a very large populational study with another large control group.
Asunto(s)
Ventilación del Oído Medio/efectos adversos , Otitis Media con Derrame/cirugía , Otitis Media Supurativa/etiología , Otitis Media Supurativa/prevención & control , Complicaciones Posoperatorias/prevención & control , Agua , Niño , Preescolar , Oído Medio/metabolismo , Femenino , Humanos , Incidencia , Modelos Logísticos , Masculino , Otitis Media Supurativa/epidemiología , Portugal/epidemiología , Complicaciones Posoperatorias/epidemiología , Calidad de Vida , Estudios Retrospectivos , Factores de Riesgo , Prevención Secundaria , Resultado del TratamientoRESUMEN
Introducción: La otitis media con efusión (OME) sigue siendo la patología otológica más prevalente en los preescolares de Chile; su etiología y factores predisponentes aún no están del todo claro; por ende su tratamiento es controversial. Objetivo: Demostrar una correlación microbiológica en cultivos de tejido adenoídeo y glue de ambos oídos en pacientes con OME. Material y método: Estudio prospectivo caso/control, donde se analizaron los cultivos bacterianos de tejido adenoideo y glue de ambos oídos en 40 pacientes con OME y cultivos bacterianos de tejido adenoídeo de 40 pacientes con hiperplasia adenoídea sin OME. Resultados: Casos: Cinco cultivos negativos de adenoides (12,5%), 28 positivos a comensales (70%) y 7 positivos a gérmenes no habituales (17,5%). El glue presentó cultivo negativo en 72,5% OD y 77,5% OI. Los cultivos de adenoides en los controles no difieren mayormente a los casos. Discusión: No se pudo establecer una correlación microbiológica entre glue y adenoides en pacientes con OME. Conclusiones: El número de cultivos de glue negativos se correlaciona con la literatura mundial. No existe un patrón que permita correlacionar los cultivos de adenoides de los casos con los cultivos de glue, ni con los cultivos de adenoides de los controles.
Introduction: Otitis Media with Effusion is still the most prevalent otological pathology in preschool children in Chile. Its etiology and predisposing factors are not entirely clear yet. Hence, its treatment is controversial. Aim: To demonstrate a microbiological correlation in adenoid tissue and glue ear cultures in both ears in patients with OME. Material and method: Prospective case control study, which analyzed bacterial adenoid tissue cultures and glue ear cultures in both ears in 40 patients with OME, and a second control group of bacterial cultures in 40 patients with adenoid hyperplasia without ear effusion. Results: Cases: Five negatives in adenoid cultures (12.5%), 28 positive to guest bacteria (70%) and 7 positive at unusual germs (17.5%). The glue ear presented negative culture at 72.5% in the right ear and 77.5% in the left ear. Adenoid control cultures did not differ with OME studied cases. Discussion: A microbiological glue ear and adenoid correlation could not be established. Conclusions: The number of negative glue ear cultures is similar to published literature. There is not a pattern which allows a positive correlation between adenoid cases cultures and glue ear cultures or with control adenoid cultures.