Impact of tympanostomy tubes on child quality of life.

BACKGROUND The objective benefits of tympanostomy tubes for otitis media are well established, but the subjective impact of surgery on child quality of life (QOL) has not been systematically studied. OBJECTIVES To determine the subjective impact of tympanostomy tubes on child QOL, and to compare the variability in QOL before surgery with that observed after surgery. DESIGN Prospective, observational, before-and-after trial. SETTING Fourteen referral-based pediatric otolaryngology practices in the United States. PATIENTS Consecutive (64%) and convenience (36%) sample of 248 children (median age, 1.4 years) with otitis media scheduled for bilateral tympanostomy tube placement as an isolated surgical procedure. INTERVENTION Tympanostomy tubes were inserted as part of routine clinical care. Validated measures of QOL (OM-6 survey), satisfaction with health care decision (Satisfaction With Decision Scale), and satisfaction with office visit; surveys were completed at baseline (visit 1), at surgery (visit 2), and after surgery (visit 3). MAIN OUTCOME MEASURES Short-term changes in QOL before surgery (visit 1 to visit 2) and after surgery (visit 2 to visit 3). RESULTS Changes in QOL before surgery were mostly trivial, and were smaller than changes observed after surgery (P<.001). Large, moderate, and small improvements in QOL occurred after surgery in 56%, 15%, and 8% of children, respectively. Physical symptoms, caregiver concerns, emotional distress, and hearing loss were most improved, but significant changes were also seen for activity limitations and speech impairment. Trivial changes occurred in 17% of children, and 4% had poorer QOL. Predictors of poorer QOL were otorrhea 3 or more days (10% of variance) and decreased satisfaction with surgical decision (3% of variance). Hearing status, child age, type of otitis media (recurrent vs chronic), and office visit satisfaction were unrelated to outcome. CONCLUSIONS Tympanostomy tubes produce large short-term improvements in QOL for most children. The best outcomes occur when postoperative otorrhea is absent or minimal, and when parents are satisfied with their initial decision to have surgery. Further research is needed to document the long-term impact of tubes on child QOL.

[1]  D L Sackett,et al.  Clinical recommendations using levels of evidence for antithrombotic agents. , 1995, Chest.

[2]  E. Mandel,et al.  Acute Otorrhea: Bacteriology of a Common Complication of Tympanostomy Tubes , 1994, The Annals of otology, rhinology, and laryngology.

[3]  Outcomes management: a technology of patient experience. , 1989, The New England journal of medicine.

[4]  D. Osoba,et al.  Measuring health-related quality of life. , 1999, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[5]  W H Rogers,et al.  Patients' ratings of outpatient visits in different practice settings. Results from the Medical Outcomes Study. , 1993, JAMA.

[6]  Ellwood Pm,et al.  Shattuck Lecture--outcomes management. A technology of patient experience. 1988. , 1997, Archives of pathology & laboratory medicine.

[7]  Lewis E. Kazis,et al.  Effect Sizes for Interpreting Changes in Health Status , 1989, Medical care.

[8]  M. Liang,et al.  Comparisons of Five Health Status Instruments for Orthopedic Evaluation , 1990, Medical care.

[9]  J. Arnold,et al.  Prevention of recurrent acute otitis media: Chemoprophylaxis versus tympanostomy tubes , 1986 .

[10]  R A Deyo,et al.  Reproducibility and responsiveness of health status measures. Statistics and strategies for evaluation. , 1991, Controlled clinical trials.

[11]  N. Facione.  Quality of life issues in chronic otitis media with effusion: parameters for future study. , 1991, International journal of pediatric otorhinolaryngology.

[12]  D. E. Gebhart.  Tympanostomy tubes in the otitis media prone child. , 1981, The Laryngoscope.

[13]  M. Holmes-Rovner,et al.  Patient Satisfaction with Health Care Decisions , 1996, Medical decision making : an international journal of the Society for Medical Decision Making.

[14]  G. Gates,et al.  Otitis Media Health Status Evaluation: A Pilot Study for the Investigation of Cost-Effective Outcomes of Recurrent Acute Otitis Media Treatment , 1998, The Annals of otology, rhinology, and laryngology.

[15]  J. Sidman,et al.  Topical ofloxacin versus systemic amoxicillin/clavulanate in purulent otorrhea in children with tympanostomy tubes. , 1998, International journal of pediatric otorhinolaryngology.

[16]  C. Strunk,et al.  Posttympanostomy otorrhea: The efficacy of canal preparation , 1992, The Laryngoscope.

[17]  K. Sweeney,et al.  Personal significance: the third dimension , 1998, The Lancet.

[18]  M. Tos,et al.  Hearing loss in tympanosclerosis caused by grommets. , 1989, Archives of otolaryngology--head & neck surgery.

[19]  R. Corbridge,et al.  Grommets and patient satisfaction: an audit. , 1997, Annals of the Royal College of Surgeons of England.

[20]  M. Johns.  The medical appropriateness of tympanostomy tubes proposed for children younger than 16 years in the United States. , 1994, Archives of otolaryngology--head & neck surgery.

[21]  R. Rosenfeld,et al.  Quality of life for children with otitis media. , 1997, Archives of otolaryngology--head & neck surgery.

[22]  R. Kane,et al.  The relationship of patient satisfaction with care and clinical outcomes. , 1997, Medical care.

[23]  H. Rockette,et al.  Efficacy of antimicrobial prophylaxis and of tympanostomy tube insertion for prevention of recurrent acute otitis media: results of a randomized clinical trial , 1992, The Pediatric infectious disease journal.

[24]  K. Daly,et al.  Predictors for postoperative otorrhea following tympanostomy tube insertion. , 1992, Archives of otolaryngology--head & neck surgery.

[25]  N. Goldstein,et al.  A Meta‐Analysis of Swimming and Water Precautions , 1999, The Laryngoscope.

[26]  G H Guyatt,et al.  Determining a minimal important change in a disease-specific Quality of Life Questionnaire. , 1994, Journal of clinical epidemiology.

[27]  T J Prihoda,et al.  Effectiveness of adenoidectomy and tympanostomy tubes in the treatment of chronic otitis media with effusion. , 1987, The New England journal of medicine.

[28]  H. Rockette,et al.  Myringotomy with and without tympanostomy tubes for chronic otitis media with effusion. , 1989, Archives of otolaryngology--head & neck surgery.

[29]  A. Adelman.  Water precautions in children with tympanostomy tubes. , 1996, The Journal of family practice.

[30]  H. Rockette,et al.  Efficacy of myringotomy with and without tympanostomy tubes for chronic otitis media with effusion , 1992, The Pediatric infectious disease journal.