TRANSTYMPANIC VENTILATION TUBES IN TODDLERS AND SMALL TUBES IN TODDLERS AND SMALL

CHILDRENCHILDREN

Mattheus W. Vischer

Kathrin Vischer

ENT clinic

Audiology and pediatric audiology

Gümligen Bern SwitzerlandGümligen Bern Switzerland

CONDUCTIVE HARING LOSSCONDUCTIVE HARING LOSS

otitis media with effusion cleft palate atelectasis of the middle ear cleft palate atelectasis of the middle ear cleft palate perforation of the ear drum middle ear dysplasia otosclerosis

fracture of the temporal boneC it l h l t t Congenital cholesteatoma

Vischer Mattheus, Vischer Kathrin, Siloah Clinic, Otology and Audiology, Pediatric Audiology AlexORL2010 April 21-23

PEDIATRIC AUDIOLOGY - DIAGNOSTICSPEDIATRIC AUDIOLOGY DIAGNOSTICS

anamnesis, history of hearing loss ear microscopyear microscopy tympanometry

b h i l di t behavioural audiometry objective audiometry:

– TEOAEABR– ABR

– Stapedial reflex

Vischer Mattheus, Vischer Kathrin, Siloah Clinic, Otology and Audiology, Pediatric Audiology AlexORL2010 April 21-23

BEHAVIOUR AUDIOMETRY

Vischer Mattheus, Vischer Kathrin, Siloah Clinic, Otology and Audiology, Pediatric Audiology AlexORL2010 April 21-23

BEHAVIOUR AUDIOMETRY

Vischer Mattheus, Vischer Kathrin, Siloah Clinic, Otology and Audiology, Pediatric Audiology AlexORL2010 April 21-23

TEOAE: PRESENT OR ABSENT?

if TEAOE absent:

estmated HL

b t 35 dB

Vischer Mattheus, Vischer Kathrin, Siloah Clinic, Otology and Audiology, Pediatric Audiology AlexORL2010 April 21-23

about 35 dB

ABR - BRAINSTEM AUDIOMETRY

NEWBORNup to 3 months: as a rule no sedation

After nursingAfter nursingawake or in

t lVischer Mattheus, Vischer Kathrin, Siloah Clinic, Otology and Audiology, Pediatric Audiology AlexORL2010 April 21-23

spontaneous sleep

ABR – BRAINSTEM AUDIOMETRY

Right ear Left earRight ear Left ear

dB

85

65

55

45

35

25

Vischer Mattheus, Vischer Kathrin, Siloah Clinic, Otology and Audiology, Pediatric Audiology AlexORL2010 April 21-23

MILD HEARING LOSSMILD HEARING LOSS

Vischer Mattheus, Vischer Kathrin, Siloah Clinic, Otology and Audiology, Pediatric Audiology AlexORL2010 April 21-23

OTITIS MEDIA WITH EFFUSIONOTITIS MEDIA WITH EFFUSION

EFFUSION

Middle ear partiallyp yaerated

Prognosis favorable Prognosis favorable

Milde hearing loss

Ventilation of theEustachian tube withOtoventTM Ballons

NO GROMMETS

Vischer Mattheus, Vischer Kathrin, Siloah Clinic, Otology and Audiology, Pediatric Audiology AlexORL2010 April 21-23

NO GROMMETS

ATELEKTASIS 1st GRADE

Tympanon aerated

Fixed retraction pockets Fixed retraction pockets

Mild conductive HL

Ventilation with OtoventTM

balloons

Consider long term drainage

Vischer Mattheus, Vischer Kathrin, Siloah Clinic, Otology and Audiology, Pediatric Audiology AlexORL2010 April 21-23

ATELEKTASIS 1st GRADE

left right

T t di t i d t hi d

Vischer Mattheus, Vischer Kathrin, Siloah Clinic, Otology and Audiology, Pediatric Audiology AlexORL2010 April 21-23

Tympano stapediopexy, tympano incudopexy, atrophic ear drum

CONDUCTIVE HEARING LOSSCONDUCTIVE HEARING LOSS

Vischer Mattheus, Vischer Kathrin, Siloah Clinic, Otology and Audiology, Pediatric Audiology AlexORL2010 April 21-23

OTITIS MEDIA WITH EFFUSIONOTITIS MEDIA WITH EFFUSION

N l dNormal ear drum

Conductive hearing loss Paracentesis Drainage

Vischer Mattheus, Vischer Kathrin, Siloah Clinic, Otology and Audiology, Pediatric Audiology AlexORL2010 April 21-23

Conductive hearing loss Paracentesis, Drainage

VENTILATION TUBESVENTILATION TUBES

Ch i f th t f t A f th hildChoice of the type of grommets: Age of the child, cooperative behaviour, Duration of ventilation

mostly T tubes in every case in cleft ypalate: 2 to 4 years often in OMC with effusion: 3 to 4 monthseffusion: 3 to 4 months

Rarely Tübinger tubes In very young children

Vischer Mattheus, Vischer Kathrin, Siloah Clinic, Otology and Audiology, Pediatric Audiology AlexORL2010 April 21-23

short term

GOOD T TUBE

• Longterm grommet• Good T tubes• Good T tubes

Micromedics• Very soft• Gentle extraction in• Gentle extraction in

the ENT chair

Vischer Mattheus, Vischer Kathrin, Siloah Clinic, Otology and Audiology, Pediatric Audiology AlexORL2010 April 21-23

GROMMETS

Vischer Mattheus, Vischer Kathrin, Siloah Clinic, Otology and Audiology, Pediatric Audiology AlexORL2010 April 21-23

GROMMETSGROMMETS

COMPLICATIONS• Eventually infections with otorhea• Eventually infections with otorhea• Short acting local treatment with antibiotics

• Otosporin or other Aminoglycoside• Frequent recurrent otitis media• Frequent recurrent otitis media• In a few cases: early extraction or change to

an other product was necessary

Vischer Mattheus, Vischer Kathrin, Siloah Clinic, Otology and Audiology, Pediatric Audiology AlexORL2010 April 21-23

FOLLOW UP WITH GROMMETS

Vischer Mattheus, Vischer Kathrin, Siloah Clinic, Otology and Audiology, Pediatric Audiology AlexORL2010 April 21-23

LONG LASTING GROMMETS

Complication of T tubes:persistent perforationpersistent perforation

2 cases:2 cases:no problemsno infectionsno infectionsaudiologically not significant1 child of ophthalmologist1 child of ophthalmologist

Vischer Mattheus, Vischer Kathrin, Siloah Clinic, Otology and Audiology, Pediatric Audiology AlexORL2010 April 21-23

CLINICALLY NORMAL HEARING

Vischer Mattheus, Vischer Kathrin, Siloah Clinic, Otology and Audiology, Pediatric Audiology AlexORL2010 April 21-23

m.vischer@hin.chm.vischer@hin.ch

Vischer Mattheus, Vischer Kathrin, Siloah Clinic, Otology and Audiology, Pediatric Audiology AlexORL2010 April 21-23