Middle ear fluid common in kids on ventilators
Date:
April 4, 2022
Source:
UT Southwestern Medical Center
Summary:
Babies and toddlers who need a tracheostomy -- a tube surgically
inserted into their windpipe to help relieve breathing problems --
are at a high risk of accumulating fluid behind their eardrum when
on a ventilator.
That's the conclusion of a new study by head and neck surgeons. This
buildup of fluid, called a middle ear effusion, can put them at
risk for ear infections, hearing loss, and delays in speech and
language development.
FULL STORY ========================================================================== Babies and toddlers who need a tracheostomy -- a tube surgically
inserted into their windpipe to help relieve breathing problems --
are at a high risk of accumulating fluid behind their eardrum when
on a ventilator. That's the conclusion of a new study, published
in theInternational Journal of Pediatric Otorhinolaryngology, by UT Southwestern head and neck surgeons. This buildup of fluid, called a
middle ear effusion, can put them at risk for ear infections, hearing
loss, and delays in speech and language development.
==========================================================================
"The majority of the time that these children are being cared for, the
focus is on more pressing lung and heart concerns," said study leader
Stephen R.
Chorney, M.D., M.P.H., Assistant Professor of Otolaryngology -- Head
& Neck Surgery at UTSW and Pediatric Otolaryngologist at Children's
Health. "But our study suggests we should also be mindful of things
that might appear more trivial, like ear effusions, because they can
impact communication skills and developmental milestones in a vulnerable population of kids." Many young children who require a tracheostomy
were born prematurely with underdeveloped lungs or narrow airways. In
these cases, doctors may attach a mechanical ventilator -- a form of
life support to help a child breathe -- to the tracheostomy tube.
Middle ear effusion (MEE) is a common problem for all young
children. Nearly one in ten kids have ear tubes placed to help clear
this fluid, treat infections, and reduce hearing loss. Dr. Chorney
and his colleagues suspected, based on their own observations, that tracheostomy-dependent children on a ventilator might be at a higher
risk of MEE.
The new study followed 94 children who received a tracheostomy before
the age of two at Children's Medical Center Dallas between 2015 and
2020. On average, the children underwent tracheostomy at 5 months old and
would then periodically obtain hearing tests to determine the presence
of MEE. In the two years following their tracheostomy, 74% of children requiring mechanical ventilation developed at least one MEE while only 31%
of those not on the ventilator developed a MEE. When controlling for age, diagnosis of craniofacial syndrome, and result of newborn hearing test, mechanical ventilation predicted the presence of a MEE. Further, among
all children with a tracheostomy, 80% of MEEs persisted for at least
several months, between multiple hearing exams.
"This information allows us to have an objective reference point when communicating with parents," said Dr. Chorney. "We know that this is
a common phenomenon and we might consider ear tubes in some of these
children." Since placing ear tubes requires general anesthesia, some
children with a tracheostomy on ventilator support might not be good
candidates for the procedure, and the new data helps clinicians weigh
risks and benefits. In future studies, Dr. Chorney would like to explore
the impact of MEEs on hearing and communication in this population.
"What we would hope is that if we're more vigilant with screening for
and addressing MEEs in these children, positive outcomes on speech and
language development can be achieved," he said. "But we need more data
on that."
========================================================================== Story Source: Materials provided by UT_Southwestern_Medical_Center. Note: Content may be edited for style and length.
========================================================================== Journal Reference:
1. Erin M. Wynings, Hussein Jaffal, Rachel St. John, Romaine
F. Johnson,
Stephen R. Chorney. Mechanical ventilation and middle ear
effusions among tracheostomy-dependent children. International
Journal of Pediatric Otorhinolaryngology, 2022; 155: 111062 DOI:
10.1016/j.ijporl.2022.111062 ==========================================================================
Link to news story:
https://www.sciencedaily.com/releases/2022/04/220404150124.htm
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