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Austad et al. BMC Ear, Nose and Throat Disorders 2014,

14:2http://ww w.io!ed" e ntral."o!/1 4#2$%&1'/14/2

(E)EA(C* A(T+CE -pen A""ess

Can eneral pra"titioners do the ollow$upsater surer with entilation tues in thet!pani" !e!rane Two ears audioloi"aldataB3arne Austad

1,2,+rene *etlei5

1,6eard Buten

7,4,)iri 8enner

4,Anita *elene -lsen

4and Anne$)oie *eli5

1,4

Astra"t

Ba"5round: A uniersit hospital in Mid$Norwa has !odiied their uidelinesor ollow$up ater insertion oentilation tues 96Ts in the t!pani" !e!rane, transerrin the "ontrols o the healthiest "hildren to eneral

pra"titioners 9;


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Dedi"ation waier9http: //"reatie"o!!ons . or/puli"do!ain/ero/1.0/ applies to the data !ade aailale in this arti"le,unless otherwise stated.
http://creativecommons.org/publicdomain/zero/1.0/http://creativecommons.org/publicdomain/zero/1.0/http://creativecommons.org/publicdomain/zero/1.0/


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Austad et al. BMC Ear, Nose and Throat Disorders 2014,14:2


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uidelines and "lini"al 3ud!ent. The s"heduled ollow$

ups were not alwas in "on"ordan"e with the uideline

re"o!!endations or where the "hildren a"tuall had

their "ontrols or dierent reasons F77G. iure 1 "ontains

a low"hart o lo"aliation o ollow$ups.

The parti"ipantswere in"luded ater inor!ed written

"onsent. Due to Norweian reulations parents/uard$

ians had to ie "onsent on their own ehal and on

e$ hal o "hildren under the ae o 1%. Adoles"ents 1%

ears and older "onsented on ehal o the!seles. The

stud was approed the (eional Ethi"s Co!!ittee

in )Jr$ TrJndela 9200/1''$2 and the Norweian

)o"ial )"i$ en"e Data )eri"e 9N)D.

Audioloi"al testin eore and 24 O 7 !onths ater

surer

+nor!ation aout the audioloi"al tests prior to

surerwas otained ro! the !edi"al re"ord o the parti"i$

pants. The testin ater surer was "o!!itted at the

hospital two e=perien"ed audioloistsin a soundproo

roo!. Ceru!en was re!oed prior to e=a!ination.

Based on the re"orded indins, the "hildren with need

were oered a !edi"al e=a!ination with an otolarn$

oloist within a ew das.

The audioloi"al !easures "onsisted o a pure tone

audiora!, spee"h re"onition tests and t!pano!etr.

+n "ases where the "hild due to ae or other reasons

"ould not "ooperate in these inestiations, pla audi$

o!etr or inor!al hearin tests were used. (esults ro!

at least three o the pure tone thresholds in de"iel 9dBat 0.'@1@2@4 5* had to e present to e analed as

!ean threshold F74G. The spee"h re"onition tests were

!easured with a phoneti"all alan"ed 91 !onosllai"

Norweian word list spe"iall !ade or "hildren and with

92 three$word e=pressions 9nu!eral P ad3e"tie P noun

F7'G. The a"ousti"al e?uip!ent was "alirated a""ordin

to +nternational -raniation or )tandardiation F7%,7#G

and ollowed re"o!!ended pro"edures F7&,7G. T!pa$

no!etr 9;)+ T!pstar@Middle Ear Analer, ;rason$

)tadler +n" was used to assess the status o !iddle

ear un"tionin F40G. The results were "ateoried as

either tpeA,B or C a""ordin to standard rules F41G.

)el$report ?uestionnaire

The ?uestionnaire in"luded 1% ?uestions, a!on the!

?uestions aout su3e"tie hearin and ear "o!plaints,

nu!er o 6T sureries the had one throuh, date o

their !ost re"ent surer, lo"ation and re?uen" o

ollow$upsater surer,and eentualreerral a"5 to an

otolarnoloist. )o"io$de!oraphi"inor!ationin"luded

parental edu"ation and o""upation. The ?uestions had

een pilot tested a!on e!ploees at the Ear$Nose$

Throat depart!ent eore used in the stud.

)tatisti"al !ethods

The roups were analed a""ordin to where the parti"$

ipantswere s"heduled to hae ollow$ups at ti!eo sur$

er, not a""ordin to the uideline re"o!!endations.

Children s"heduled or ollow$ups the outpatient

"lini" 9n > 4' and priate otolarnoloists 9n > '

were analed as one roup, the otolarnoloist roup.

91

GP

Guideline

recommended

follow-ups, n=11

7

& 20

Otolaryng

ologist

Guideline

recommended

follow-ups, n=62

42

92Follow-ups

recommended at time

of surgery, n=23

2

Follow-ups

recommended at time

of surgery, n=51

7

# 17 1 414 2#

97 !ctual follow-ups"o follow-ups recei#ed2, n=5

!ctual follow-ups

recei#ed , n=1 $%ared care &'ot% GP and

otolaryngologist(, n=2)

recei#ed , n=2*

iure 1 o"aliation o ollow$ups or the parti"ipants 9n > #7 a""ordin to: 91 the uidelines, 92 the re"o!!endations at ti!e

o surer, and 97 the a"tual "ontrol.1Missin data ro! two parti"ipants

2(easonsor no ollow$ups are e=plored in a preious paper

F77G.


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Data was read opti"all, ?ualit assured and then ana$

led with ) de"iel

'T!pano!etr tpe B, not enlared ear "anal olu!e.


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Tale 2 Audioloi"al !easures and parental report tpe o ollow$up 24 O 7 !onths ater surer0

Co!pleted 9n Tpe o ollow$up S 9' C+

;< -tolar0noloist ;< -tolarnoloist

Audio!etr01

Mean threshold2

est ear, !ean 9)D dB7

22 '0 11.# 9%.% 1%.2 911.# $4.' dB 9$., 0.&Mean threshold worst ear, !ean 9)D dB 22 4& 1.0 911.2 20.& 914.0 $1. dB 9$&.%, 4.

)pee"h re"onition tests

1. Three$words e=pression4

Best ear '0 per"eption, !ean 9)D dB 1% 77 1#.0 9%.& 20.# 9%.& $7.# dB 9$#., 0.'

8orst ear '0 per"eption, !ean 9)D dB 1' 72 2'. 917.7 2%.& 912.& $0, dB 9$.0, #.2

2 Monosllai" words

Best ear !a= per"eption, !ean 9)D dB 22 41 70.2 9#.' 71.' 9%.1 $1.2 dB 9$4.#, 2.7

8orst ear !a= per"eption, !ean 9)D dB 22 40 7#.# 911.4 7#.4 9#. 0.' dB 9$4.%, '.7

T!pano!etr

Eusion in one or oth !iddle ears'

,n 9 27 4 % 92%.1 12 924.' 1.% 9$20.0, 27.2


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Audioloi"al out"o!e

An in"reasin nu!er o studies, in"ludin the preious

!entioned Co"hrane report F%G, hae "on"luded that

there is little or no lon$ter! hearin ee"t o 6T sur$

er F42,47G. This "hallenes the need or all "hildren to

e "ontrolled an otolarnoloist, i.e. at a !ore e=$

pensie health"are leel than pri!ar "are. +n

"ontrast to the Co"hrane report, our stud

de!onstrated i!$ proed hearin and etter !iddle ear

un"tion two ears ater surer. -ur !aterial was

s!all, and one$ourth o the patients had underone

another surer in the ollow$up period. Also, the

interpretation o eusion in the !iddle ear is dii"ult

e"ause o the possiilit o inter"urrent disease iin

eusion or a short period. This i!pli"ates that the

results should e interpreted "areull. *oweer,

despite ad3ust!ent or re$surer, ae and shared

"are, the i!proe!ent o the hearin thresholds and!iddle ear un"tion were not ae"ted the roup o

phsi"ians doin the ollow$ups. As ar as we 5now,

er ew studies hae inestiated dieren"es in

audioloi"al out"o!e the ollow$up strate.

*andlin "o!pli"ations

Controls ater 6T surer are pra"ti"ed dierentl inter$

nationall, and as the )wedish )BH "on"luded there is no

eiden"e that one wa is superior to another F1%G. Thus,

on"e surer has een peror!ed, it is i!portant to

"on$ trol or "o!pli"ations and to ollow up the disease

that led to surer F&G. )o!e "lai! that deleatin

"ontrols to the ;


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+* is spe"ialist in eneral pra"ti"e and proessor.6B is an otolarnoloist and asso"iate proessor.A*- and )8 are audioloists.A)* is (N and resear"her.

A"5nowlede!ents

This wor5 was proided the Norweian Medi"al Asso"iationRs unds or(esear"h in ;eneral seeWlin5Xan"hor>*24Y*24G

. a DU, Nelson M, (osen/eld (M: Meta$analsis o t!panosto! tuese?uelae. -tolarnol *ead Ne"5 )ur 2001, 12494:7#4@7&0.

10. A!eri"an A"ade! o


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77. Austad B, *etlei5 +, Buten 6, 8enner ), -lsen A*, *eli5 A):

+!ple!entin uidelines or ollow$up ater surer with entilationtue in the t!pani" !e!rane in Norwa: a retrospe"tie stud. BMCEar Nose Throat Disord 2017, 17:2.

74. European wor5in roup on eneti"s o hearin i!pair!ent, +noletter2: European Co!!ission Dire"torate, Bio!edi"al and *ealth (esear"h

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