Follow-up audiometry after bilateral myringotomy and tympanostomy tube insertion

Objective: There are no evidence-based guidelines regarding timing of postoperative audiometric follow-up for children undergoing tympanostomy tube insertion. Given the variability of follow-up among physicians, we attempt to guide the timing of postoperative audiograms using objective data. Study design: Retrospective chart review. Methods: All pediatric patients undergoing primary bilateral myringotomy and tympanostomy tube insertion for otitis media with effusion who had audiometric data available at two follow-up times were identified from 2014. Patients were classified according to the type of audiometry performed and were further categorized into those who had tympanostomy tube insertion only and those who had concurrent adenotonsillectomies. Results: 34 patients were included in the study. Among patients assessed by sound field audiometry, the mean sound field threshold value was 29.2 dB preoperatively and improved to 21 dB 2 weeks postoperatively and 17.9 dB 6 to 10 weeks postoperatively. The difference between the two postoperative means was significant (p < 0.0001). For patients evaluated by pure-tone audiometry, the mean preoperative air-bone gap was 20.1 dB; this improved to 10 dB at the first postoperative visit and 7.3 dB at the second visit. The difference between the two means was significant (p < 0.0001). For the subgroups in which adjunct adenotonsillectomy was performed, the greater improvement at the later follow-up was still statistically significant. Conclusions: Progressive hearing improvement was demonstrated from 2 weeks to 6 to 10 weeks postoperatively. We recommend testing no fewer than 6 weeks after tympanostomy tube insertion. Earlier audiometry underestimates the degree of hearing improvement. (C) 2015 Elsevier Ireland Ltd. All rights reserved.