BACKGROUNDThe objective benefits of tympanostomy tubes for otitis media are well established, but the subjective impact of surgery on child quality of life (QOL) has not been systematically studied.OBJECTIVESTo determine the subjective impact of tympanostomy tubes on child QOL, and to compare the variability in QOL before surgery with that observed after surgery.DESIGNProspective, observational, before-and-after trial.SETTINGFourteen referral-based pediatric otolaryngology practices in the United States.PATIENTSConsecutive (64%) and convenience (36%) sample of 248 children (median age, 1.4 years) with otitis media scheduled for bilateral tympanostomy tube placement as an isolated surgical procedure.INTERVENTIONTympanostomy tubes were inserted as part of routine clinical care. Validated measures of QOL (OM-6 survey), satisfaction with health care decision (Satisfaction With Decision Scale), and satisfaction with office visit; surveys were completed at baseline (visit 1), at surgery (visit 2), and after surgery (visit 3).MAIN OUTCOME MEASURESShort-term changes in QOL before surgery (visit 1 to visit 2) and after surgery (visit 2 to visit 3).RESULTSChanges in QOL before surgery were mostly trivial, and were smaller than changes observed after surgery (P<.001). Large, moderate, and small improvements in QOL occurred after surgery in 56%, 15%, and 8% of children, respectively. Physical symptoms, caregiver concerns, emotional distress, and hearing loss were most improved, but significant changes were also seen for activity limitations and speech impairment. Trivial changes occurred in 17% of children, and 4% had poorer QOL. Predictors of poorer QOL were otorrhea 3 or more days (10% of variance) and decreased satisfaction with surgical decision (3% of variance). Hearing status, child age, type of otitis media (recurrent vs chronic), and office visit satisfaction were unrelated to outcome.CONCLUSIONSTympanostomy tubes produce large short-term improvements in QOL for most children. The best outcomes occur when postoperative otorrhea is absent or minimal, and when parents are satisfied with their initial decision to have surgery. Further research is needed to document the long-term impact of tubes on child QOL.

From Sekhet’enanch in Egypt, to Empedocles in Greece, to Galen in Rome, an awareness of disorders of the ear, nose, and throat slowly emerged among those early individuals who were called physicians. However, an ignorance of physical relationships we now take for granted as well as ingrained superstitions barred significant advancement in medical knowledge until much more recent times. Gradually, clouds cleared, and in 1521 Berengar adequately described structures of the larynx. Vesalius described the cranial nerves and Bahuinus named the muscles of the head and neck. In 1809 Bott published accurate colored plates of the anatomy of the nose and throat, and in 1860 Toynbee published his classic Diseases of the Ear. As a result of more accurate descriptions of head and neck anatomy, sounder medical treatment began to close the gap between knowledge of the human body and the cure of its ailments. In 1730 Martine performed a tracheotomy for airway obstruction and devised a tracheotomy tube with a removable inner cannula. Tympanostomy was proposed by Saunder in 1806 as a treatment of middle ear suppuration. In 1838 Yearsley became the first to practice as an ear, nose, and throat specialist. From that point the concept of individuals concentrating only on diseases of the ear, nose, and throat gained acceptance, and knowledge of anatomy, physiology, and pathology of the head and neck moved forward more rapidly. Since the turn of the century, names such as Jackson, Hansen, Killian, Cawthome, Lempert, Holmgren, Barany, and, more recently, Shambaugh, House, Bordley, and Ogura have gained special prominence in the history of otolaryngology. This course will strive to familiarize the practicing otolaryngologist with those individuals who, through the ages, paved the way for more modem medical approaches and to acquaint the practitioner with the accomplishments of more recent physicians who have brought otolaryngology into the forefront of modem medicine. Videotapes of prominent individuals in the field will be presented showing personal experiences of significant events that will directly relate to the audience. COURSE 3502 Convention Center 2 Periods 5-6 Two-period course ($20)