DALLAS – April 4, 2022 – Babies and toddlers who require a tracheostomy – a tube surgically inserted into their windpipe to relieve breathing problems – are at high risk of building up fluid behind their eardrums while on a ventilator. That’s the conclusion of a new study, published in the International Journal of Pediatric Otorhinolaryngology, by head and neck surgeons at UT Southwestern. This buildup of fluid, called a middle ear effusion, can put them at risk for ear infections, hearing loss, and delays in speech and language development.
Stephen R. Chorney, MD, MPH
“Most of the time these children are cared for, the focus is on more pressing lung and heart problems,” said study leader Stephen R. Chorney, MD, MPH, assistant professor of ENT – Head & Neck Surgery at UTSW and Kinder otolaryngologist at Children’s Health. “But our study suggests that we also need to be aware of things that may seem more trivial, such as ear effusions, because they can affect communication skills and developmental milestones in a vulnerable population of children.”
Many young children requiring a tracheostomy were born prematurely with underdeveloped lungs or narrow airways. In these cases, doctors may attach a mechanical ventilator — a form of life support to help a child breathe — to the tracheostomy tube.
Middle ear effusion (MEE) is a common problem for all young children. Nearly one in ten children have ear tubes placed to remove this fluid, treat infections and reduce hearing loss. dr. Chorney and his colleagues suspected, based on their own observations, that tracheostomy-dependent children on a ventilator might have a higher risk of MEE.
The new study followed 94 children who received a tracheostomy before the age of two at Children’s Medical Center Dallas between 2015 and 2020. On average, the children underwent a tracheostomy at 5 months of age and would then have periodic hearing tests to determine the presence of MEE. In the two years following their tracheostomy, 74% of children requiring mechanical ventilation developed at least one MEE, while only 31% of those not on the ventilator developed a MEE. When controlling for age, diagnosis of craniofacial syndrome and result of newborn hearing test, mechanical ventilation predicted the presence of a MEE. Furthermore, 80% of MEEs of all children with a tracheostomy persisted for at least several months, between multiple hearing exams.
“This information allows us to have an objective point of reference when communicating with parents,” said Dr. chorney. “We know this is a common phenomenon and we might consider ear tubes in some of these children.”
Since ear tube placement requires general anesthesia, some children who have a ventilator-assisted tracheostomy may not be good candidates for the procedure, and the new data is helping clinicians weigh risks and benefits. In future studies, Dr. Chorney wanted to investigate the impact of MEEs on hearing and communication in this population.
“What we would hope is that if we are more vigilant about screening for and addressing MEEs in these children, positive outcomes on speech and language development can be achieved,” he said. “But we need more data on that.”
Other UTSW researchers who contributed to this study included Erin M. Wynings, Hussein Jaffal, Rachel St. John, and Romaine F. Johnson.
About UT Southwestern Medical Center
UT Southwestern, one of the nation’s premier academic medical centers, integrates cutting-edge biomedical research with exceptional clinical care and education. The institution’s faculty has received six Nobel Prizes and includes 25 members of the National Academy of Sciences, 16 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute Investigators. Its full-time faculty of more than 2,800 people is responsible for pioneering medical advances and is committed to quickly translating science-based research into new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 117,000 hospitalized patients, more than 360,000 emergency care cases, and oversee nearly 3 million outpatient visits per year.
About children’s health
Children’s Health℠ is committed to making children’s lives better. As one of the largest and most prestigious pediatric health care providers in the nation and the leading pediatric health care system in North Texas, Children’s Health cares for children through more than 750,000 patient visits per year. The Children’s Health System includes the flagship hospital, Children’s Medical Center Dallas, as well as Children’s Medical Center Plano, Our Children’s House Inpatient Rehabilitation Hospital, the Children’s Health Care Network, specialty centers, rehabilitation facilities, and physician services. Children’s Medical Center Dallas remains the only hospital in North Texas to be ranked 10 out of 10 pediatric specialties by US News & World Report. Through its academic ties to UT Southwestern Medical Center, Children’s Health is a leader in life-changing treatments, innovative technology and groundbreaking research. This affiliation led to the creation of the Children’s Medical Center Research Institute in 2011, which is committed to research in regenerative medicine, cancer biology, and metabolism. For more information, follow Children’s Health at: facebook† Twitter† Instagram† LinkedIn† YouTube or visit Childrens.com†
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