Atelectasis of the middle ear in pediatric patients: safety of surgical intervention

Abstract

Objective: There is no consensus amongst clinicians regarding the best treatment strategy for pediatric atelectasis of the middle ear. It is the policy in our pediatric otolaryngology department to intervene early in the disease process. In an attempt to provide evidence regarding the safety of early intervention we have analyzed the audiological outcome following surgery in different stages of the disease.

Study design: Retrospective case note review.

Methods: We undertook a retrospective study of children with atelectasis treated surgically at a Dutch tertiary referral centre. Disease severity was classified according to the Erasmus Classification of Pediatric Atelectasis, and pre- and postoperative four frequency ac and bc thresholds were compared.

Results: The study group consisted of 169 ears in 127 patients. The mean age at surgery was 9.6 years. There was an improvement in the average air-bone gap (ABG) for all stages. No deterioration in mean bone conduction thresholds was found following surgical intervention and there were no dead ears postoperatively.

Conclusion: This study demonstrated that surgical intervention had a favourable effect on hearing level across all stages, though hearing was markedly worse in stage V, and that a policy of intervention early in the disease process cannot be rejected on the grounds of risk of iatrogenic sensorineural hearing loss.