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Tympanostomy Tubes in Children: A Clinical Practice Guideline

August 12, 2013

Tympanostomy Tubes in Children: A Clinical Practice Guideline

  1. Louis M. Bell, MD

Twelve evidence-based recommendations on patient selection, surgical indications, and management for insertion of tympanostomy tubes.

  1. Louis M. Bell, MD

Sponsoring Organization: The American Academy of Otolaryngology — Head and Neck Surgery Foundation

Target Population: Specialists, primary care clinicians, and allied health professionals involved in managing children aged 6 months to 12 years with tympanostomy tubes (TTs)

Purpose: To provide evidence-based recommendations on patient selection, surgical indications, and management for insertion of tympanostomy tubes — the most common ambulatory surgery performed in children in the U.S. Despite the frequency of insertion, no guidelines exist that provide specific indications for surgery. These guidelines were developed by a panel of experts who surveyed available literature and considered situations tube insertion was deemed optional, recommended, or not recommended. Additional discussions included opportunities for quality improvement, including shared decision-making and care of children with existing tubes.

Recommendations: The 12 recommendations are summarized as follows:

  • Do not perform TT in children with otitis media with effusion (OME) for <3 months.

  • Perform hearing testing if OME is chronic (>3 months) prior to TT insertion.

  • Offer TTs in children with chronic bilateral OME and hearing difficulty.

  • TTs are optional in children with chronic OME with symptoms (e.g., vestibular problems, poor school performance, behavioral problems, ear discomfort).

  • Monitor children with chronic OME every 3 to 6 months to determine hearing loss and symptoms.

  • Do not perform TT in children with recurrent acute otitis media (AOM) without effusion.

  • Offer TTs in children with recurrent AOM with unilateral or bilateral effusion.

  • Identify children with otitis media who are at risk for speech, language, or learning problems because of baseline sensory, physical, cognitive, or behavioral factors.

  • Consider TT insertion in at-risk children with chronic OME (>3 months) or OME that is likely to be persistent based on tympanography.

  • Educate caregivers perioperatively about TT functionality, follow-up schedule, and complications.

  • Prescribe topical antibiotic ear drops for acute TT otorrhea. Oral antibiotics are not indicated.

  • Do not recommend water precautions in children with TTs.

Comment

These guidelines are a welcome addition to the literature. Although based largely on expert opinion, it provides a starting place as we strive to reduce variation in the management of children with chronic otitis media with effusion.

  • Disclosures for Louis M. Bell, MD at time of publication Grant / research support Institutional Clinical and Translational Science Award; National Center for Pediatric Practice Based Research Learning Editorial boards Current Problems in Pediatric Adolescent Healthcare Leadership positions in professional societies Academic Pediatric Association (Chair, Academic General Pediatrics Fellowship Accreditation Committee)

Citation(s):

Reader Comments (1)

Mervyn Garrett MBBS Physician, Allergy/Immunology, Gold Coast Australia

Refer you to NSouli Bellanti J et al Role of food Allergy in Serous Otitis Media Annal Allergy 1994;73:215-9. Many other supportive articles. You have to define the etiological factor. Grommets are remedial treatment only. With ENT surgeon we saw near 200 cases of recurrent SOM and in all, milk was a major factor.

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