A randomised controlled trial of surgery for glue ear. Spontaneous resolution of severe chronic glue ear in children and the effect of adenoidectomy, tonsillectomy, and insertion of ventilation tubes (grommets). A prospective randomized trial of adenoidectomy vs grommet insertion in the treatment of glue ear. A randomized study of the surgical management of children with persistent otitis media with effusion associated with a hearing impairment. OTOSCOPIC, IMPEDANCE, AND AUDIOMETRIC FINDINGS IN GLUE EAR TREATED BY ADENOIDECTOMY AND TONSILLECTOMY: A Prospective Randomised Study Grommets and Glue Ear: A Five-Year Follow up of a Controlled Trial 1 Prospective study of tympanosclerosis developing after grommet insertion. The mini-grommet and tympanosclerosis: results at two years. Bacteriological aspects of swimming with grommets. The long term outcome of secretory otitis media in children and the effects of surgical treatment: a ten year study.
OBJECTIVE --To assess the effect of five different surgical treatments for glue ear ( secretory otitis media ) on improvement in hearing and , assuming one or more treatments to be effective , to identify the appropriate indications for surgery . DESIGN --R and omised controlled trial of children receiving ( a ) adenoidectomy , bilateral myringotomy , and insertion of a unilateral grommet ; ( b ) adenoidectomy , unilateral myringotomy , and insertion of a unilateral grommet ; ( c ) bilateral myringotomy and insertion of a unilateral grommet ; and ( d ) unilateral myringotomy and insertion of a grommet .  Children were followed up at seven weeks , six months , 12 months , and 24 months by symptom history and clinical investigations . SETTING --Otolaryngology department in an urban hospital . PATIENTS --149 Children aged 4 - 9 years who were admitted for surgery for glue ear and who had no history of previous operations on tonsils , adenoids , or ears and no evidence of sensorineural deafness . Inadequate follow up information on levels of hearing and on middle ear function was obtained from 22 . MAIN OUTCOME MEASURES --Mean hearing loss ( dB ) of the three worst heard frequencies between 250 and 4000 Hz , results of impedance tympanometry , and parental views on their child 's progress . RESULTS --In the 127 children for whom adequate information was available ears in which a grommet had been inserted performed better in the short term ( for at least six months ) than those in which no grommet had been inserted , irrespective of any accompanying procedure . Most of the benefit had disappeared by 12 months . Adenoidectomy produced a slight improvement that was not significant , though was sustained for at least two years . The ears of children who had had an  adenoidectomy  with myringotomy and grommet insertion , however , continued to improve so that two years after surgery about 50 % had abnormal tympanometry compared with 83 % of those who had had only myringotomy and grommet insertion , and 93 % of the group that had had no treatment . Logistic regression analyses identified preoperative hearing level as the single best predictor of good outcome from surgery . Other variables contributed little additional predictive power . CONCLUSIONS --If the principal objective of surgery for glue ear is to restore hearing then our study shows that insertion of grommets is the treatment of choice . The addition of an adenoidectomy will increase the likelihood of restoration of normal function of the middle ear but will not improve hearing . When deciding appropriate indications for surgery , a balance has to be made between performing unnecessary operations and failing to treat patients who might benefit from surgical intervention . Preoperative audiometry scores might be the best predictor in helping to make this decision OBJECTIVE --To measure the time to spontaneous resolution of severe chronic otitis media with effusion ( glue ear ) in children and study the effects of adenoidectomy , adenotonsillectomy , and ventilation tubes ( grommets ) . DESIGN --R and omised controlled study over 12 years . SETTING --Paediatric otorhinolaryngology clinics and in-patient unit . SUBJECTS--228 children aged 2 - 9 years with pronounced hearing loss from glue ear and persistent bilateral middle ear effusions confirmed on three occasions over three months . INTERVENTIONS --Children were r and omly allocated to adenotonsillectomy , adenoidectomy , or neither procedure . In all groups a Shepard type ventilation tube was inserted in one r and omly chosen ear . Follow up was annually for five years and then less often for up to seven years four months . For analysis the two operated groups were combined . MAIN OUTCOME MEASURES --Otoscopic clearance of fluid , change in tympanogram , and improvement in mean audiometric hearing threshold . RESULTS --Survival analysis showed appreciable otoscopic and tympanometric resolution of fluid with ventilation tubes alone and adenoidectomy alone compared with no surgery . Further improvement was seen after combination of both treatments . Mean audiometric hearing thresholds improved with fluid resolution . Resolution was delayed in younger children and in those whose parents smoked , irrespective of treatment . Whereas a single insertion of a Shepard tube resolved the glue for a mean ( SD ) period of 9.5 ( 5.2 ) months , the effect of adenoidectomy was sustained throughout follow up . CONCLUSIONS --Treatment of glue ear considerably shortened the time to fluid resolution , combined adenoidectomy and tube insertion being better than either procedure alone . Resolution was longer in younger children and those whose parent(s ) smoked , irrespective of treatment The  treatment of deafness secondary to glue ear by grommet insertion  is compared to The object of this study was to compare the effect on the hearing of the insertion of a grommet , with or without adenoidectomy , against a non-surgically managed control ear in children with persistent hearing impairment due to otitis media with effusion . Seventy-eight children ( 44 boys , 34 girls , mean age 5.8 years ) with documented bilateral otitis media with effusion associated with a bilateral hearing impairment ( pure tone average air conduction thresholds over 0.5 , 1 and 2 kHz of > or = 25 dB HL ) over a three month period were admitted to a r and omized , controlled trial . Each child was r and omized to have or not to have an adenoidectomy . The ears in each child were then r and omly allocated to have a grommet ( tympanostomy tube ) inserted . The children 's hearing status was review ed six and 12 months post-operatively . During follow-up , should a child redevelop a persistent bilateral hearing impairment ( as defined above ) for three months they were managed with a hearing aid . Thus no child had repeat insertion of a grommet . Surgery of each type had an effect on the hearing and the presence of otitis media with effusion at six months post-operatively but not at 12 months when it was no different from natural resolution . If resolution of the otitis media with effusion is the outcome measure , then adenoidectomy alone is significantly better than no surgery but only in boys rather than in girls . Even in boys it only resolves about 60 per cent of effusions . However , when combined with a grommet ( one insertion ) adenoidectomy gives no greater resolution ( 89 per cent compared with 86 per cent ) . ( ABSTRACT TRUNCATED AT 250 WORDS 150 children aged between 2 and 9 years ( mean 5.25 years ) with chronic bilateral otitis media with effusion were r and omly allocated to three groups who , in addition to unilateral myringotomy and grommet insertion  , would have an adenotonsillectomy , an adenoidectomy , or neither . The contralateral ear was assessed . Otoscopic , impedance , and audiometric findings were recorded preoperatively and at six and twelve months postoperatively . Subtraction of the no-surgery results indicates that at twelve months adenoidectomy produces otoscopic resolution of OME in 41.7 % and no-peak/peak conversion of impedance in 29.8 % . The hearing gain from adenoidectomy alone was similar to that result ing from insertion of a grommet alone , but the children having adenoidectomy required fewer reinsertions to maintain adequate subjective hearing thresholds in the treated ear ( 26 % versus 54 % ) . Tonsillectomy conferred no additional benefit . Without treatment there was a small but significant improvement in all indices at twelve months but not at six months postoperatively Material and methods Sixty children aged between 4 and 10 years with seromucinous otitis media in both ears were originally included , but 5 failed to attend for follow up , thus leaving a total of 55 ( 92 % followup rate ) . In each instance the diagnosis was made on a careful history , otoscopy and pure tone audiometry . Under a general anaesthetic both ears were inspected with the microscope , and at r and om selection only one ear was drained and a Shephard grommet was inserted anteroinferiorly through a radial incision . A careful adenoidectomy was performed , along with whatever other surgery was required in the upper respiratory tract . Pure tone audiometry was repeated forty-eight hours postoperatively and prior to discharge from hospital . Thereafter , follow up was carried out at three-monthly intervals for the first year and then review ed five years later . On each visit otoscopy and pure tone audiometry were performed and at the five-year review impedance measurement was also carried out Grommets have been used as a treatment for middle-ear effusions since their introduction by Armstrong in 1954 . However , it is now accepted that the presence of a grommet in a tympanic membrane is associated with the development of tympanosclerosis in that membrane . Furthermore , it has been shown that this is a progressive phenomenon and that the incidence increases with time to as much as 65 per cent at 3 to 4 years after grommet insertion ( Mawson and Fagan , 1972 ; Tos and Poulsen , 1976 ) . Initially it was suggested that the development of tympanosclerosis might be due to the middle ear disease rather than to the grommet ( McKinnon , 1971 ) . However , most recent studies have found that , in bilateral cases of effusion , tympanosclerosis develops more frequently in ears with a grommet than in those without ( Brown , Richards and Ambegaokar , 1978 ; Lildholt , 1979 ) . This prospect i ve study was design ed to show the development of tympanosclerosis in the tympanic membrane of children treated for bilateral middle-ear effusions and to elicit any factors from the clinical history and operative technique which might be associated with the pathogenesis of the complication One hundred and sixteen children with otitis media with effusion ( OME ) underwent surgery with grommet insertion . A conventional Shah grommet was used in one ear , and a Mini-Shah grommet in the other . Final review of the subjects two years after surgery revealed a significantly lesser degree of tympanosclerosis in the ear into which the Mini-Shah grommet had been inserted . This benefit might have result ed from the lesser mass of the mini-tube or its shorter duration in situ A prospect i ve bacteriological and symptomatic study was carried out on 50 swimmers and 50 non-swimmers who had grommets inserted for secretory otitis media . The risk of developing otorrhoea with positive bacterial pathogens was similar for swimmers ( 7.9 % ) and non-swimmers ( 8.0 % ) . Subdividing the non-swimmers into ' wetters ' and ' strictly dry ' there was a similar risk of ear symptoms and pathogens . All children who swim before the insertion of grommets should continue to do so postoperatively with no added risk of ear infections Two hundred and twenty two children with bilateral secretory otitis media were allocated at r and om for adenoidectomy , adenotonsillectomy  or for neither  procedure . In all cases only a unilateral grommet was inserted . The contralateral unoperated ear was examined during a ten year period to show otoscopic clearance , change in tympanometric status and improvement in mean hearing threshold .  Adenoidectomy or insertion of a grommet alone produces similar improvement but in combination are more effective than either procedure in isolation . The unoperated ear in cases not receiving either procedure reflects the natural history of the condition . It shows a steady improvement in all outcome measures as time passes
ConclusionS -carboxymethylcysteine is effective in the treatment of children with glue ear .
Objective To establish the clinical relevance of S-carboxymethylcysteine in the treatment of glue ear in children using measures approximating those saving a child from operation for grommet insertion .