The first evidence-based clinical practice guideline on tympanostomy tubes in children aged 6 months to 12 years has been published by the American Academy of Otolaryngology-Head and Neck Surgery in the journal Otolaryngology-Head and Neck Surgery.
Tympanostomy tubes are placed in the eardrum to treat persistent middle ear fluid (effusion), frequent ear infections, or persistent ear infections despite antibiotic therapy.
This multidisciplinary guideline serves to help physicians identify children most likely to benefit from tympanostomy tubes, provide the best care pre- and post-surgery, and improve counseling and education for parents.
The development group made the following strong recommendation: clinicians should prescribe topical antibiotic eardrops only, without oral antibiotics, for children with uncomplicated acute tympanostomy tube otorrhea.
The development group made the following recommendations:
1) Do not perform tympanostomy tube insertion in children with a single episode of otitis media with effusion (OME) of <3 months’ duration
2) Obtain an age-appropriate hearing test if OME persists for >3 months (chronic OME) or prior to surgery when a child becomes a candidate for tympanostomy tube insertion
3) Offer bilateral tympanostomy tube insertion to children with chronic bilateral OME and documented hearing difficulties
4) Reevaluate, at 3- to 6-month intervals, children with chronic OME who did not receive tympanostomy tubes until the effusion is no longer present, significant hearing loss is detected, or structural abnormalities of the tympanic membrane or middle ear are suspected
5) Do not perform tympanostomy tube insertion in children with recurrent acute otitis media (AOM) who do not have middle ear effusion in either ear at the time of assessment for tube candidacy
6) Offer bilateral tympanostomy tube insertion to children with recurrent AOM who have unilateral or bilateral middle ear effusion at the time of assessment for tube candidacy
7) Determine if a child with recurrent AOM or with OME of any duration is at increased risk for speech, language, or learning problems from otitis media because of baseline sensory, physical, cognitive, or behavioral factors
8) In the perioperative period, clinicians should educate caregivers of children with tympanostomy tubes regarding the expected duration of tube function, recommended follow-up schedule, and detection of complications
9) Do not encourage routine, prophylactic water precautions (use of earplugs, headbands; avoidance of swimming or water sports) for children with tympanostomy tubes
For more information call (703) 836-4444 or visit www.entnet.org/guide_lines/tubes.cfm.