Clinical Practice Guideline: Tympanostomy Tubes in Children

Abstract

Objective. Insertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the United States. Tympanostomy tubes are most often inserted because of persistent middle ear fluid, frequent ear infections, or ear infections that persist after antibiotic therapy. Despite the frequency of tympanostomy tube insertion, there are currently no clinical practice guidelines in the United States that address specific indications for surgery. This guideline is intended for any clinician involved in managing children, aged 6 months to 12 years, with tympanostomy tubes or being considered for tympanostomy tubes in any care setting, as an intervention for otitis media of any type.Purpose. The primary purpose of this clinical practice guideline is to provide clinicians with evidence-based recommendations on patient selection and surgical indications for and management of tympanostomy tubes in children. The development group broadly discussed indications for tube placement, perioperative management, care of children with indwelling tubes, and outcomes of tympanostomy tube surgery. Given the lack of current published guidance on surgical indications, the group focused on situations in which tube insertion would be optional, recommended, or not recommended. Additional emphasis was placed on opportunities for quality improvement, particularly regarding shared decision making and care of children with existing tubes.Action Statements. The development group made a strong recommendation that clinicians should prescribe topical antibiotic eardrops only, without oral antibiotics, for children with uncomplicated acute tympanostomy tube otorrhea. The panel made recommendations that (1) clinicians should not perform tympanostomy tube insertion in children with a single episode of otitis media with effusion (OME) of less than 3 months' duration; (2) clinicians should obtain an age-appropriate hearing test if OME persists for 3 months or longer (chronic OME) or prior to surgery when a child becomes a candidate for tympanostomy tube insertion; (3) clinicians should offer bilateral tympanostomy tube insertion to children with bilateral OME for 3 months or longer (chronic OME) and documented hearing difficulties; (4) clinicians should 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) clinicians should 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) clinicians should 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) clinicians should determine if a child with recurrent AOM or with OME of any duration is at increased risk for sp...

Caregiver Quality of Life Is Related to Severity of Otitis Media in Children

“…Similar to prior studies, these results imply that the QoL burden of OM, not just the presence of disease, is an important factor in caregiver QoL. 7, 8 Caregiver QoL was directly correlated with caregiver levels of anxiety, depression, and fatigue and inversely correlated with caregiver satisfaction.…”

Contemporary Concepts in Management of Acute Otitis Media in Children

“…58 These issues have been addressed by a national “overuse” summit that included tympanostomy tube placement as 1 of the 5 potentially overused treatments, 59 as well as by the recent publication of a multidisciplinary clinical practice guideline on the use of tympanostomy tubes in children. 1 …”

“…The use of tympanostomy tubes for recurrent AOM is additionally refined in the recently published AAO-HNS Clinical Practice guideline for Tympanostomy Tubes in Children. 1 …”

A Patient‐Centered Approach to Clinical Practice Guidelines in Otolaryngology

“…According to the CPG: “Tympanostomy tubes in children” “clinicians should not perform tympanostomy tube insertion in children with recurrent AOM who do not have middle ear effusion in either ear at the time of assessment for tube candidacy.” 17 In the scenario presented there is no middle ear fluid and there are no mitigating circumstances, factors such as developmental delay, severe AOM, or multiple antibiotic allergies, that would support a need for tympanostomy tube surgery. According to the CPG, the best treatment is watchful waiting.…”