title: Improvement in otitis media with effusion in patients undergoing tracheostomy after prolonged endotracheal intubation.
abstract: OBJECTIVE
  Otitis media with effusion (OME) has a higher incidence in adult intensive care unit (ICU) patients. This observational study sought to examine the effect of tracheostomy on OME in critically ill patients and explore the predisposing factors.
  
  
  METHODS
  Twenty-seven ICU patients who had undergone prolonged intubation (more than 14 days) received traditional tracheostomies. Otoscopic examination, tympanometry, and spectral gradient acoustic reflectometry were performed both at the time of the tracheostomy and 7 days later. We collected data on the patients' demographics (age and gender), underlying diseases, duration of intubation prior to the tracheostomy, history of gastroesophageal reflux disease, length of antibiotic use, level of consciousness, and presence of nasogastric tubes.
  
  
  RESULTS
  At the time of the tracheostomy, 25 (46%) ears from 14 (52%) patients were classified as cases of OME, 17 (31%) ears and 7 (26%) patients as normal cases, and 12 (11%) ears from 6 (11%) patients as cases of negative pressure in the tympanic cavity. Seven days after the tracheostomy, OME was resolved in 17 (68%) ears and persisted in 6 (24%) ears, whereas negative pressure developed in 2 (8%) ears. Our data showed that the incidence of OME reduced from 46% to 22% after tracheostomy was performed on the patients.
  
  
  CONCLUSIONS
  The incidence of OME in adult ICU patients who were intubated for more than 14 days was found to reduce after tracheostomy. Notably, the rate of improvement in the conscious patients was significantly higher than that in the unconscious patients.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung City, Taiwan.
authors.forename: Hsiung-Kwang
authors.initials: HK
authors.lastname: Chung
authors.forename: Ching-Chia
authors.initials: CC
authors.lastname: Lin
authors.forename: Chin-Yuan
authors.initials: CY
authors.lastname: Wang
authors.forename: Chia-Der
authors.initials: CD
authors.lastname: Lin
authors.forename: Ming-Hsui
authors.initials: MH
authors.lastname: Tsai
authors.forename: Chia-Sheng
authors.initials: CS
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D016638:Critical Illness; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010034:Otitis Media with Effusion / Q000209:etiology*; D013997:Time Factors; D014140:Tracheotomy; D055815:Young Adult