Revista de medicina pulmonar

A novel protocol for audiology screening and prevention of serousotitis media in infants with tracheostomy

Noa Bar

Serous Otitis Media (SOM) is commonly encountered in infants with tracheostomy. In particular, children with tracheostomies for long-term mechanical ventilation have been identified as being at increased risk for Chronic SOM, which can lead to hearing impairments and a delay in the development of speech and language. This highlights the importance of prevention and early diagnosis of SOM in this population. To the best of our knowledge, however, standardized protocols for SOM screening and treatment for tracheostomized infants have not been reported to date. The Department of Respiratory Rehabilitation at ALYN Pediatric Rehabilitation Hospital is a tertiary referral center specializing in rehabilitation of tracheostomized children, discharging 70 to 80 such children to ongoing home ventilation in Israel annually. A multidisciplinary team from ALYN Hospital, Hadassah University Hospital, and Tel Aviv University, comprising ENT and pulmonary rehabilitation physicians, audiologists and speech and language therapists, all with extensive experience treating children with tracheostomies and with hearing impairment, developed a protocol for routine screening and suggested management of SOM in this population. Highlights The new protocol identifies clinical indications and recommends timing for regular otoscopy and hearing evaluations in these children, and recommends that tympanostomy tubes be inserted at the time of initial tracheostomy whenever possible. Criteria for identifying those who could benefit from early tympanostomy to prevent long-term consequences of SOM are presented. The protocol includes timing for informing parents on their child’s hearing condition. The protocol identifies the importance of an integrated, multidisciplinary clinical approach in order to improve the diagnosis and rehabilitation for this particular patient group. The protocol is presented as a flow chart in poster format, including a review of the literature on this subject.