What are the Long Term Effects and Stratifiers on Hearing from Having Tympanostomy Tube Insertion? A Systematic Review

Middle ear disease is common in childhood and is often associated with hearing loss. Seventy-one percent of all children have at least an episode of Otitis Media with Effusion (OME) by the age of three. The high incidence of OME in patients with middle ear disease has led to the conclusion that treatment with Tympanostomy Tube Insertion (TTI) would solve the inevitable hearing loss associated with middle ear disease. Studies reporting an association between hearing loss and TTI are conflicting and warrant a systematic review of the evidence.

A dual review process was used to assess eligible studies drawn from PubMed, Medline via Ovid, and Science direct, reference lists from 2007 to 2018. Five studies were selected.

Three studies did not specify a primary outcome measure in terms of the types of hearing loss i.e. did not specifically measure CHL and reported benefits in hearing with TTI. The other studies reported incidences of CHL with the use of the TTI.Shorter tubes tended to reduce long term complications. Tube stay-time was on average 6-12 months and required follow up as a result of an increase in complications. The number of insertions was positively correlated with children with symptomatic pathology. Tube location is important as medial displacement can occur as well as not checking tube function. Children aged from zero to six years old benefitted the most from TTI as their hearing loss tended to be the greatest at the baseline compared to older children.

An extensive systematic review identified five studies examining hearing loss and TTI in young children from 2007 to 2018. There are two main findings from this review. First, two studies reported hearing loss in two studies with TTI. Second, the association between hearing loss and TTI may be influenced by the type of hearing loss measure, technical aspects of TTI, and demographic and health characteristics. These findings are strengthened by evidence from a large (n = 3128) globally representative sample of young adults. A proportion of children may experience conductive hearing loss with TTI, and we recommend allied health professionals and general practitioners increase their awareness and understanding of the hearing loss experienced during TTI.