Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Resolution of Middle Ear Effusion in Newborns

Resolution of Middle Ear Effusion in Newborns Abstract Objectives: To determine the natural history of middle ear effusion (MEE) in newborns and compare the results of pneumatic otoscopy with tympanometry and acoustic reflex measurements in the evaluation of the middle ear of neonates. Design: A descriptive natural history study with comparison of three evaluation methods for MEE. Setting: County hospital nursery and pediatric clinic. Participants: Sixty-eight full-term, healthy neonates were studied on day 1 of life; 65 on day 2; and 24 on day 3. Thirty-eight infants returned at 2 weeks of age, and from this group, 23 returned at 2 months of age. Interventions: Two independent observers performed otoscopy. An audiologist performed tympanometry and ipsilateral acoustic reflex measurements. Infants were evaluated daily from birth by all three methods for up to 3 days. Main Outcome Measure: The time to resolution of MEE as determined by three methods. Results: In the first 3 hours of life, all babies examined had MEE diagnosed in both ears. By the third day, MEE apparently had resolved in 73% of ears by otoscopy, 88% by acoustic reflex measurements, and 92% by tympanometry. At 2 weeks, MEE was present by otoscopy in 13% (10/75 of ears). These were primarily newly acquired MEEs. Interobserver agreement by otoscopy as determined by k scores was moderate on days 1 and 3, poor on day 2, and excellent at 2 weeks and 2 months. Conclusions: Middle ear effusion diagnosed by otoscopy apparently resolves in 72 hours in most neonates. Interobserver agreement of otoscopists was excellent after babies were discharged from the nursery, suggesting that pneumatic otoscopy can be used to diagnose MEE in neonates this age. Most MEEs that are diagnosed 2 weeks and 2 months after birth are new and asymptomatic.(Arch Pediatr Adolesc Med. 1995;149:873-877) References 1. deSa DJ. Infection and amniotic aspiration of middle ear in stillbirths and neonatal deaths . Arch Dis Child . 1973;48:872-880.Crossref 2. McLellan MS, Webb CH. Ear studies in the newborn infant . J Pediatr . 1961; 58:523-527.Crossref 3. Paradise JL, Smith CG, Bluestone CD. Tympanometric detection of middle ear effusion in infants and young children . Pediatrics . 1979;58:198-210. 4. Groothuis JR, Sell SH, Wright PF, Thompson JM, Altemeier WA. Otitis media in infancy: tympanometric findings . Pediatrics . 1979;63:435-442. 5. Marchant CD, McMillan PM, Shurin PA, et al. Objective diagnosis of otitis media in early infancy by tympanometry and ipsilateral acoustic reflex thresholds . J Pediatr . 1986;109:590-595.Crossref 6. McMillan PM, Marchant CD, Shurin PA. Ipsilateral acoustic reflexes in infants . Ann Otol Rhinol Laryngol . 1985;94:145-148. 7. McMillan PM, Bennett MJ, Marchant CD, Shurin PA. Ipsilateral and contralateral acoustic reflexes in neonates . Ear Hear . 1985;6:320-324.Crossref 8. Kramer MS, Feinstein AR. Clinical biostatistics LIV: the biostatistics of concordance . Clin Pharmacol Ther . 1981;29:111-123.Crossref 9. McLellan MS, Brown Jr, Rondeau H, Shoughro E, Johnson RA, Hale AR. Embryonal connective tissue and exudate in ear . AJDC . 1964;108:164-170. 10. Shurin A, Pelton SI, Klein JO. Otitis media in the newborn infant . Ann Otol Rhinol Laryngol . 1976;85:216-222. 11. Piza JE, Gonzalez MP, Northrup CC, Eavey RD. Meconium contamination of the neonatal middle ear . J Pediatr . 1989;115:910-914.Crossref 12. Jaffe BF, Hurtado F, Hurtado E. Tympanic membrane mobility in the newborn . Laryngoscope . 1967;80:36-48.Crossref 13. Cavanaugh RM. Pneumatic otoscopy in healthy full-term infants . Pediatrics . 1987;79:520-523. 14. Shurin PA, Pelton SI, Finkelstein BA. Tympanometry in the diagnosis of middle ear effusion . N Engl J Med . 1977;296:412-417.Crossref 15. Holte L, Cavanaugh RM, Margolis RH. Ear canal mobility and tympanometric shape in young infants . J Pediatr . 1990;117:77-80.Crossref 16. Pestalozza G, Cusmano G. Evaluation of tympanometry in diagnosis and treatment of otitis media of the newborn and of the infant . Int J Pediatr Otorhinolaryngol . 1980;2:75-82.Crossref 17. Himelfarb MZ, Popelka GR. Tympanometry in normal neonates . J Speech Hear Res . 1979;22:179-191. 18. Keith RW. Middle ear function in neonates . Arch Otolaryngol . 1975;101:376-379.Crossref 19. Keith RW. Impedance audiometry with neonates . Arch Otolaryngol . 1973;97: 465-467.Crossref 20. Geddes NK. Tympanometry and the stapedial reflex in the first five days of life . Int J Pediatr Otorhinolaryngol . 1987;13:293-297.Crossref 21. McCandless GA, Allred PL. Tympanometry and emergence of the acoustic reflex in infants . In: Harford ER, Bess FH, Bluestone CD, et al, eds. Impedance Screening for Middle Ear Disease in Children . New York, NY: Grune & Stratton; 1978:56-67. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

Loading next page...
 
/lp/american-medical-association/resolution-of-middle-ear-effusion-in-newborns-Q06RcFt0PF
Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpedi.1995.02170210047008
Publisher site
See Article on Publisher Site

Abstract

Abstract Objectives: To determine the natural history of middle ear effusion (MEE) in newborns and compare the results of pneumatic otoscopy with tympanometry and acoustic reflex measurements in the evaluation of the middle ear of neonates. Design: A descriptive natural history study with comparison of three evaluation methods for MEE. Setting: County hospital nursery and pediatric clinic. Participants: Sixty-eight full-term, healthy neonates were studied on day 1 of life; 65 on day 2; and 24 on day 3. Thirty-eight infants returned at 2 weeks of age, and from this group, 23 returned at 2 months of age. Interventions: Two independent observers performed otoscopy. An audiologist performed tympanometry and ipsilateral acoustic reflex measurements. Infants were evaluated daily from birth by all three methods for up to 3 days. Main Outcome Measure: The time to resolution of MEE as determined by three methods. Results: In the first 3 hours of life, all babies examined had MEE diagnosed in both ears. By the third day, MEE apparently had resolved in 73% of ears by otoscopy, 88% by acoustic reflex measurements, and 92% by tympanometry. At 2 weeks, MEE was present by otoscopy in 13% (10/75 of ears). These were primarily newly acquired MEEs. Interobserver agreement by otoscopy as determined by k scores was moderate on days 1 and 3, poor on day 2, and excellent at 2 weeks and 2 months. Conclusions: Middle ear effusion diagnosed by otoscopy apparently resolves in 72 hours in most neonates. Interobserver agreement of otoscopists was excellent after babies were discharged from the nursery, suggesting that pneumatic otoscopy can be used to diagnose MEE in neonates this age. Most MEEs that are diagnosed 2 weeks and 2 months after birth are new and asymptomatic.(Arch Pediatr Adolesc Med. 1995;149:873-877) References 1. deSa DJ. Infection and amniotic aspiration of middle ear in stillbirths and neonatal deaths . Arch Dis Child . 1973;48:872-880.Crossref 2. McLellan MS, Webb CH. Ear studies in the newborn infant . J Pediatr . 1961; 58:523-527.Crossref 3. Paradise JL, Smith CG, Bluestone CD. Tympanometric detection of middle ear effusion in infants and young children . Pediatrics . 1979;58:198-210. 4. Groothuis JR, Sell SH, Wright PF, Thompson JM, Altemeier WA. Otitis media in infancy: tympanometric findings . Pediatrics . 1979;63:435-442. 5. Marchant CD, McMillan PM, Shurin PA, et al. Objective diagnosis of otitis media in early infancy by tympanometry and ipsilateral acoustic reflex thresholds . J Pediatr . 1986;109:590-595.Crossref 6. McMillan PM, Marchant CD, Shurin PA. Ipsilateral acoustic reflexes in infants . Ann Otol Rhinol Laryngol . 1985;94:145-148. 7. McMillan PM, Bennett MJ, Marchant CD, Shurin PA. Ipsilateral and contralateral acoustic reflexes in neonates . Ear Hear . 1985;6:320-324.Crossref 8. Kramer MS, Feinstein AR. Clinical biostatistics LIV: the biostatistics of concordance . Clin Pharmacol Ther . 1981;29:111-123.Crossref 9. McLellan MS, Brown Jr, Rondeau H, Shoughro E, Johnson RA, Hale AR. Embryonal connective tissue and exudate in ear . AJDC . 1964;108:164-170. 10. Shurin A, Pelton SI, Klein JO. Otitis media in the newborn infant . Ann Otol Rhinol Laryngol . 1976;85:216-222. 11. Piza JE, Gonzalez MP, Northrup CC, Eavey RD. Meconium contamination of the neonatal middle ear . J Pediatr . 1989;115:910-914.Crossref 12. Jaffe BF, Hurtado F, Hurtado E. Tympanic membrane mobility in the newborn . Laryngoscope . 1967;80:36-48.Crossref 13. Cavanaugh RM. Pneumatic otoscopy in healthy full-term infants . Pediatrics . 1987;79:520-523. 14. Shurin PA, Pelton SI, Finkelstein BA. Tympanometry in the diagnosis of middle ear effusion . N Engl J Med . 1977;296:412-417.Crossref 15. Holte L, Cavanaugh RM, Margolis RH. Ear canal mobility and tympanometric shape in young infants . J Pediatr . 1990;117:77-80.Crossref 16. Pestalozza G, Cusmano G. Evaluation of tympanometry in diagnosis and treatment of otitis media of the newborn and of the infant . Int J Pediatr Otorhinolaryngol . 1980;2:75-82.Crossref 17. Himelfarb MZ, Popelka GR. Tympanometry in normal neonates . J Speech Hear Res . 1979;22:179-191. 18. Keith RW. Middle ear function in neonates . Arch Otolaryngol . 1975;101:376-379.Crossref 19. Keith RW. Impedance audiometry with neonates . Arch Otolaryngol . 1973;97: 465-467.Crossref 20. Geddes NK. Tympanometry and the stapedial reflex in the first five days of life . Int J Pediatr Otorhinolaryngol . 1987;13:293-297.Crossref 21. McCandless GA, Allred PL. Tympanometry and emergence of the acoustic reflex in infants . In: Harford ER, Bess FH, Bluestone CD, et al, eds. Impedance Screening for Middle Ear Disease in Children . New York, NY: Grune & Stratton; 1978:56-67.

Journal

Archives of Pediatrics & Adolescent MedicineAmerican Medical Association

Published: Aug 1, 1995

References