Long-term follow-up after otitis media in childhood
Sammanfattning: Objective: Most preschool children have suffered from at least one episode of acute otitis media (AOM) and/or secretory otitis media (SOM). Some children have frequent AOM episodes and/or prolonged and recurrent episodes of secretory otitis media (SOM). The long-term out-come and sequelae are not fully clarified. Subjects and methods: Out of a birth cohort followed to the age of 3 years, 12 children with 6 or more acute otitis media episodes before the age of 3 years (rAOM) were followed-up at the age of 10 years. Fifty-two young subjects with secretory otitis media during at least 6 years (refractory SOM) were followed-up after resolved SOM. The clinical course was found by interviewing the subjects and from scrutiny of medical records. Tympanic membrane changes were detected by otomicroscopy and audiometric examinations were performed. The Eustachian tube function was examined in the SOM group. The results were compared with control groups. Results: The rAOM group continued to have more AOM episodes than the controls up to the age of 7 years. When compared with the controls, the rAOM subject had higher hearing levels at high-frequency (8 - 16 kHz) and acoustic middle ear reflex thresholds were elevated, the middle ear compliance was higher and the middle ear pressures were lower. Myringosclerosis was found in 58% of the rAOM group. Patients whose onset of refractory SOM was related to an episode of acute otitis media were younger at SOM debut than those who had no such relation. Otorrhea and AOM episodes were more frequent during the SOM periods with blocked or expelled tubes than during periods with patent tubes. The SOM group had poorer hearing than the controls at all air conduction frequencies except 1.5 kHz in the range 0.125–16 kHz, and at some of the bone conduction frequencies. The hearing loss was worst for the highest frequencies. Those with the most protracted disease had the highest high frequency thresholds. This was not related to an increased duration of time spent with middle ear effusion but to numerous myringotomies and tube insertions and longer total duration spent with patent tubes. The youngest subjects with previous SOM had more atrophy than the older subjects and more myringosclerosis was observed in subjects with shorter interval between SOM ending and examination. The SOM subjects had significantly poorer active tubal function than the controls; i.e. poorer inability to equilibrate negative or negative and positive middle ear pressure. The majority of the SOM subjects still experienced some kind of discomfort in their ears at the time of examination. Conclusion: Protracted and/or recurrent otitis media may result in impaired hearing despite meticulous controls during the disease history. The impaired hearing at follow-up of subjects with refractory SOM in childhood has a partly cochlear origin in some, but not all, cases.
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