SP02. Outcomes after First Myringotomy Tube Insertion in Children with Cleft Pathology Treated at an Approved ACPA Centre
Notice bibliographique
Résumé
PURPOSE: Children born with cleft palate and/or lip (CP, CLP) have a high incidence of early and recurrent otitis media with effusion (OME) associated with hearing loss, due to impaired middle ear ventilation. Management consists of early myringotomy & tube insertion, often performed at the time of cleft palate repair. The literature indicates that tube insertion improves the hearing in short term, but there is minimal long-term differences when compared with children who did not have tubes inserted. Complications associated with the myringotomy & tube insertion include episodes of otorrhea, tympanic membrane perforation, recurrent OME with need for tube reinsertion and cholesteatoma formation. There is minimal evidence to indicate if the complications rate is higher amongst children with an orofacial cleft pathology (OFC) after initial myringotomy & tube. There is also no clear standard in terms of the adequate frequency and length of follow up period.Our aim is to determine the effectiveness, the prevalence and predictor factors for complications associated with the first insertion of myringotomy tubes in children with OFC when compared with non-OFC patients in an accredited ACPA centre. METHODS: This is a retrospective matched cohort 1:3 study using administrative data from CHEO Research Warehouse. The intervention group includes patients born with CP/CLP pathology (OFC cohort), had the cleft palate repair before 24 months of age and their 5th birthday was before 31/03/2020. The control group (non-OFC cohort) did not include any children with OFC and was matched on gender and date of birth ± 30 days. RESULTS: The OFC cohort had 56 patients and in the non-OFC cohort were matched to 168 patients. In the OFC cohort, 73.2% had tube insertions at the time of cleft repair and 26.8% afterwards; forty-two patients (75%) had at least another consequent surgery related to tube insertion with 39 patients having a total of 58 tube insertions (1 to 4 reinsertions). In the non-OFC group, 40% had consequent otologic surgery and 30% (51/168) had a total of 80 tube reinsertions (1-5 reinsertions). There was no difference in the incidence of otorrhea, tympanic membrane perforation, otalgia, cholesteatoma between the cleft cohort and the control. Median time to first tube reinsertion was 937 days in the OFC cohort and 720 days on the non-OFC cohort. The OFC cohort had more than twice the number of clinic follow up (p=0.001), especially for patients who did not require further tube reinsertion or with more than 2 reinsertions. Recurrent OME after the first tube insertion was a predictive factor for future reinsertion. CONCLUSION: Children with OFC pathologies have 2 fold increased risk of myringotomy tube reinsertion after the initial insertion when compared to non-OFC cohort in the first 5 years of life and with more than twice the number of follow up appointments when compared to non-OFC cohort. Despite the higher number of tube insertions in the OFC group, they did not have a significantly higher number of complications related to the tubes.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».