期刊论文详细信息
BMC Ear, Nose and Throat Disorders
Can general practitioners do the follow-ups after surgery with ventilation tubes in the tympanic membrane? Two years audiological data
Anne-Sofie Helvik3  Anita Helene Olsen3  Siri Wennberg3  Vegard Bugten3  Irene Hetlevik2  Bjarne Austad1 
[1] Sjøsiden Medical Centre, Trondheim, Norway;General Practice Research Unit, Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), PO Box 8905, 7491 Trondheim, Norway;Department of Ear, Nose and Throat, Head and Neck Surgery, St. Olavs Hospital, Trondheim, Norway
关键词: Children;    Hearing;    Clinical guidelines;    Implementation;    General practice;    Follow-up care;    Tympanostomy tubes;    Otitis media;   
Others  :  862671
DOI  :  10.1186/1472-6815-14-2
 received in 2013-09-12, accepted in 2014-04-01,  发布年份 2014
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【 摘 要 】

Background

A university hospital in Mid-Norway has modified their guidelines for follow-up after insertion of ventilation tubes (VTs) in the tympanic membrane, transferring the controls of the healthiest children to general practitioners (GPs). The aim of this study was to evaluate the implementation of these guidelines by exploring audiological outcome and subjective hearing complaints two years after surgery, assessing if follow-ups in general practice resulted in poorer outcome.

Methods

A retrospective observational study was performed at the university hospital and in general practice in Mid-Norway. Children below 18 years who underwent surgery with VTs between Nov 1st 2007 and Dec 31st 2008 (n = 136) were invited to participate. Pure tone audiometry, speech audiometry and tympanometry were measured. A self-report questionnaire assessed subjective hearing, ear complaints and the location of follow-ups. This study includes enough patients to observe group differences in mean threshold (0.5–1–2–4 kHz) of 9 dB or more.

Results

There were no preoperative differences in audiometry or tympanometry between the children scheduled for follow-ups by GPs (n = 23) or otolaryngologists (n = 50). Two years after surgery there were no differences between the GP and otolaryngologist groups in improvement of mean hearing thresholds (12.8 vs 12.6 dB, p = 0.9) or reduction of middle ears with effusion (78.0 vs 75.0%, p = 0.9). We found no differences between the groups in terms of parental reports of child hearing or ear complaints.

Conclusions

Implementation of new clinical guidelines for follow-ups after insertion of VTs did not negatively affect audiological outcomes or subjective hearing complaints two years after surgery.

【 授权许可】

   
2014 Austad et al.; licensee BioMed Central Ltd.

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【 参考文献 】
  • [1]National Institute for Health and Care Excellence (NICE): Surgical Management of Otitis Media with Effusion in Children: National Collaborating Centre for Women’s and Children’s Health (UK). London: RCOG Press; 2008.
  • [2]Rosenfeld RM, Schwartz SR, Pynnonen MA, Tunkel DE, Hussey HM, Fichera JS, Grimes AM, Hackell JM, Harrison MF, Haskell H, Haynes DS, Kim TW, Lafreniere DC, Leblanc K, Mackey WL, Netterville JL, Pipan ME, Raol NP, Schellhase KG: Clinical practice guideline: tympanostomy tubes in children. Otolaryngol Head Neck Surg 2013, 149(1 Suppl):S1-S35.
  • [3]Kvaerner KJ, Kristiansen HA, Russell MB: Otitis media history, surgery and allergy in 60-year perspective: a population-based study. Int J Pediatr Otorhinolaryngol 2010, 74(12):1356-1360.
  • [4]Caye-Thomasen P, Stangerup SE, Jorgensen G, Drozdziewic D, Bonding P, Tos M: Myringotomy versus ventilation tubes in secretory otitis media: eardrum pathology, hearing, and eustachian tube function 25 years after treatment. Otol Neurotol 2008, 29(5):649-657.
  • [5]Paradise JL, Feldman HM, Campbell TF, Dollaghan CA, Rockette HE, Pitcairn DL, Smith CG, Colborn DK, Bernard BS, Kurs-Lasky M, Janosky JE, Sabo DL, O'Connor RE, Pelham WE Jr: Tympanostomy tubes and developmental outcomes at 9 to 11 years of age. N Engl J Med 2007, 356(3):248-261.
  • [6]Browning GG, Rovers MM, Williamson I, Lous J, Burton MJ: Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev 2010, 10:CD001801.
  • [7]Lous J, Ryborg CT, Thomsen JL: A systematic review of the effect of tympanostomy tubes in children with recurrent acute otitis media. Int J Pediatr Otorhinolaryngol 2011, 75(9):1058-1061.
  • [8]Overview of tympanostomy tube placement and medical care of children with tympanostomy tubes [http://www.uptodate.com/contents/overview-of-tympanostomy-tube-placement-and-medical-care-of-children-with-tympanostomy-tubes?source=see_link&anchor=H24#H24 webcite]
  • [9]Kay DJ, Nelson M, Rosenfeld RM: Meta-analysis of tympanostomy tube sequelae. Otolaryngol Head Neck Surg 2001, 124(4):374-380.
  • [10]American Academy of Pediatrics: Follow-up management of children with tympanostomy tubes. Pediatrics 2002, 109(2):328-329.
  • [11]Rosenfeld RM, Culpepper L, Yawn B, Mahoney MC: Otitis media with effusion clinical practice guideline. Am Fam Physician 2004, 69(12):2776. 2778–2779
  • [12]Rosenfeld RM, Schwartz SR, Pynnonen MA, Tunkel DE, Hussey HM, Fichera JS, Grimes AM, Hackell JM, Harrison MF, Haskell H, Haynes DS, Kim TW, Lafreniere DC, LeBlanc K, Mackey WL, Netterville JL, Pipan ME, Raol NP, Schellhase KG, Haynes DS, Kim TW, Lafreniere DC, LeBlanc K, Mackey WL, Netterville JL, Pipan ME, Raol NP, Schellhase KG: Clinical practice guideline: tympanostomy tubes in children–executive summary. Otolaryngol Head Neck Surg 2013, 149(1):8-16.
  • [13]Derkay CS, Carron JD, Wiatrak BJ, Choi SS, Jones JE: Postsurgical follow-up of children with tympanostomy tubes: results of the American Academy of Otolaryngology-Head and Neck Surgery Pediatric Otolaryngology Committee National Survey. Otolaryngol Head Neck Surg 2000, 122(3):313-318.
  • [14]Norwegian Society of Otorhinolaryngology and Head & Neck Surgery [http://legeforeningen.no/Fagmed/Norsk-Forening-for-Otorhinolaryngologi-Hode--og-Halskirurgi/Veileder-for-ore-nese-halsfaget/Otologi/Sekretorisk-otitt/ webcite] (National recommended guidelines)
  • [15]Spielmann PM, McKee H, Adamson RM, Thiel G, Schenk D, Hussain SS: Follow up after middle-ear ventilation tube insertion: what is needed and when? J Laryngol Otol 2008, 122(6):580-583.
  • [16]The Swedish Council on Technology Assessment in Health Care: Rörbehandling vid inflammastion i mellanöret [Tympanostomy tube insertion for otitis media in children] (in Swedish, English translation). In En systematisk litteraturöversikt. Stockholm: SBU; 2008:78-84.
  • [17]Ahmed S, Shapiro NL, Bhattacharyya N: Incremental health care utilization and costs for acute otitis media in children. Laryngoscope 2014, 124(1):301-305.
  • [18]Extend Quality System (EQS): Ører - Kontroll av barn med ventilasjonsrør i trommehinnen [Follow-up care of children with ventilation tube in the tympanic membrane] (in Norwegian, English translation). St. Olavs Hospital: ; 2007.
  • [19]Extend Quality System (EQS): Til foreldre med barn med ventilasjonsrør i trommehinnen [Parental information for follow-up after surgery with ventilation tube in the tympanic membrane] (in Norwegian, English translation). St. Olavs Hospital: ; 2007.
  • [20]Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE: Knowledge translation of research findings. Implement Science 2012, 7(1):50. BioMed Central Full Text
  • [21]Spyridonidis D, Calnan M: Opening the black box: a study of the process of NICE guidelines implementation. Health Pol 2011, 102(2–3):117-125.
  • [22]Chaillet N, Dube E, Dugas M, Audibert F, Tourigny C, Fraser WD, Dumont A: Evidence-based strategies for implementing guidelines in obstetrics: a systematic review. Obstet Gynecol 2006, 108(5):1234-1245.
  • [23]Lugtenberg M, Zegers-van Schaick JM, Westert GP, Burgers JS: Why don’t physicians adhere to guideline recommendations in practice? An analysis of barriers among Dutch general practitioners. Implement Sci 2009, 4:54. BioMed Central Full Text
  • [24]Daniel M, Kamani T, El-Shunnar S, Jaberoo MC, Harrison A, Yalamanchili S, Harrison L, Cho WS, Fergie N, Bayston R, Birchall JP: National Institute for Clinical Excellence guidelines on the surgical management of otitis media with effusion: are they being followed and have they changed practice? Int J Pediatr Otorhinolaryngol 2013, 77(1):54-58.
  • [25]Hetlevik I, Holmen J, Kruger O, Kristensen P, Iversen H: Implementing clinical guidelines in the treatment of hypertension in general practice. Blood Press 1998, 7(5–6):270-276.
  • [26]de Groot S, Bevers G, Post MW, Woldring FA, Mulder DG, van der Woude LH: Effect and process evaluation of implementing standardized tests to monitor patients in spinal cord injury rehabilitation. Disabil Rehabil 2010, 32(7):588-597.
  • [27]Hetlevik I, Holmen J, Kruger O: Implementing clinical guidelines in the treatment of hypertension in general practice. Evaluation of patient outcome related to implementation of a computer-based clinical decision support system. Scand J Prim Health Care 1999, 17(1):35-40.
  • [28]Al-Hussaini A, Owens D, Tomkinson A: Have two UK national guidelines had any effect on grommets day-case utilisation and rate over the last 10 years? Eur Arch Otorhinolaryngol 2012, 269(9):2053-2056.
  • [29]Rashidian A, Eccles MP, Russell I: Falling on stony ground? A qualitative study of implementation of clinical guidelines’ prescribing recommendations in primary care. Health Pol 2008, 85(2):148-161.
  • [30]European Science Foundation. Forward Look: Implementation of medical research in clinical practice [http://www.esf.org/fileadmin/Public_documents/Publications/Implem_MedReseach_ClinPractice.pdf webcite]
  • [31]van der Wees PJ, Jamtvedt G, Rebbeck T, de Bie RA, Dekker J, Hendriks EJ: Multifaceted strategies may increase implementation of physiotherapy clinical guidelines: a systematic review. Aust J Physiother 2008, 54(4):233-241.
  • [32]Lugtenberg M, Burgers JS, Besters CF, Han D, Westert GP: Perceived barriers to guideline adherence: a survey among general practitioners. BMC Fam Pract 2011, 12:98. BioMed Central Full Text
  • [33]Austad B, Hetlevik I, Bugten V, Wennberg S, Olsen AH, Helvik AS: Implementing guidelines for follow-up after surgery with ventilation tube in the tympanic membrane in Norway: a retrospective study. BMC Ear Nose Throat Disord 2013, 13:2. BioMed Central Full Text
  • [34]European working group on genetics of hearing impairment, Infoletter 2: European Commission Directorate, Biomedical and Health Research Programme (HEAR) [http://audiology.unife.it/www.gendeaf.org/hear/infoletters/Info_02.PDF webcite]
  • [35]Øygarden J: Norwegian Speach Audiometry. Trondheim: Norwegian University of Science and Technology, Faculty of Arts; 2009. [PhD thesis]
  • [36]ISO 389-1:1998. Acoustics - reference zero for the calibration of audiometric equipment. Part 1: reference equivalent threshold sound pressure levels for pure tones and supra-aural earphones [http://www.iso.org/iso/home/store/catalogue_tc/catalogue_detail.htm?csnumber=30443 webcite]
  • [37]ISO 389-3:1994. Acoustics - reference zero for the calibration of audiometric equipment. Part 3: reference equivalent threshold force levels for pure tones and bone vibrators [http://www.iso.org/iso/home/store/catalogue_tc/catalogue_detail.htm?csnumber=22495 webcite]
  • [38]ISO 8253-2:2009. Acoustics - audiometric test methods. Part 2: sound field audiometry with pure tone and narrow-band test signals [http://www.iso.org/iso/home/store/catalogue_tc/catalogue_detail.htm?csnumber=51997 webcite]
  • [39]ISO 8253-3:2012. Acoustics -- audiometric test methods -- Part 3: speech audiometry [http://www.iso.org/iso/home/store/catalogue_tc/catalogue_detail.htm?csnumber=45101 webcite]
  • [40]GSI Tympstar Middle Ear Analyzer [http://audiometrics.net/product-list?product_id=54 webcite]
  • [41]Onusko E: Tympanometry. Am Fam Physician 2004, 70(9):1713-1720.
  • [42]Hellstrom S, Groth A, Jorgensen F, Pettersson A, Ryding M, Uhlen I, Bostrom KB: Ventilation tube treatment: a systematic review of the literature. Otolaryngol Head Neck Surg 2011, 145(3):383-395.
  • [43]Hassmann-Poznanska E, Gozdziewski A, Piszcz M, Skotnicka B: Long term sequelae of otitis media with effusion during childhood. Otolaryngol Pol 2010, 64(4):234-239.
  • [44]Kalcioglu MT, Cokkeser Y, Kizilay A, Ozturan O: Follow-up of 366 ears after tympanostomy tube insertion: why is it draining? Otolaryngol Head Neck Surg 2003, 128(4):560-564.
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