Is ADHEAR Suitable for Use in Chronic Otitis Media with Effusion?

Question

Answer

Otitis Media with Effusion (OME) is very common in childhood. In fact, a million children per year have PE tubes placed to manage OME¹. One in 15 children get PE tubes before they turn 3. In many cases tubes resolve a lot of the problems. In some cases, however, children continue to struggle. PE tubes extrude, get blocked, ears continue to drain. Such children have chronically fluctuating conductive components, perhaps for years and although they are under the care of an ENT they may struggle with a hearing impact of chronic but uncertain duration. Children with cleft and craniofacial conditions and children with Down Syndrome who may also have narrow ear canals and chronic earwax are particularly prone to these issues. 

Children who are at risk for speech and language or developmental delay need more frequent hearing assessment and prompt management to reduce or prevent an impact on developmental outcomes since the average hearing loss associated with OME in children is 28-dB HL, and for 1 in 5, the loss exceeds 35-dB HL². The at-risk group includes children with speech-language delays, developmental disabilities, academic delays and children with Down syndrome and other craniofacial anomalies in which OME is highly prevalent.

In children who have chronic OME, hearing impact and who are at risk for an impact on quality of life, school performance, behavior issues and social relationships, audiologic intervention should be considered.  If PE tube surgery is contraindicated or has a history of failure, then the hearing impact must be managed. 

What do we know about other hearing technology options for individuals with chronic conductive hearing losses of uncertain duration?

• Air conduction hearing aids in these groups are not optimal because the air-bone gap fluctuates and therefore gain adjustments are frequently needed. 

• Pressure-based bone conduction systems, using softbands or other coupling can be uncomfortable and result in low usage time. 

ADHEAR is uniquely suited to this group since it is non-surgical, pressure-free, and cosmetically appealing.  ADHEAR offers the child consistent sound input throughout the day, due to its stable placement on the mastoid, and does so regardless of fluctuations in the air-bone-gap. ADHEAR is a proven, non-invasive way to handle these chronic conductive losses. 

At MED-EL, we have seen some centers really take to ADHEAR for these groups with chronic conductive hearing losses and fluctuating air-bone-gaps. Interested readers may wish to take Course #34739 on AudiologyOnline. Rachel Sharnetzka, Au.D., of the Lancaster Cleft Palate Clinic joined Lynn Stephenson of MED-EL to review her experiences with the use of ADHEAR for children with conductive hearing loss and craniofacial differences.  

1. Myringotomy (Ear Tube Insertion) https://www.luriechildrens.org/en/specialties-conditions/myringotomy-ear-tube-insertion/

2. Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngol Head Neck Surg. 2016;154(1 Suppl):S1-S41. doi:10.1177/0194599815623467