Management of acute otitis media in cochlear implant recipients: To tube or not to tube?

Preciado, Diego; Choi, Sukgi S.

doi:10.1002/lary.22476

Cited by 8 publications

(7 citation statements)

References 5 publications

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“…This is because 16 of our 17 infectious complications occurred when there was no VT in place: 11 in ears that never had VT, and five in ears well after their tubes had extruded. This suggests that VTs are safe in cochlear implant recipients, and agrees with prior, smaller series, which also failed to find infectious complications attributable to VTs . Only one infectious complication occurred while a VT was present (case 17).…”

Section: Discussionsupporting

confidence: 88%

“…Others have also found that VTs are likely protective against complications resulting from AOM. A study by Fayad et al and others (reviewed in Preciado and Choi) found that VTs reduce the occurrence of AOM in cochlear implant recipients. These have led to a recent policy statement from the American Academy of Pediatrics, which includes the use of VT placement in the management of otitis‐prone children, before or at the time of implantation .…”

Section: Discussionmentioning

confidence: 97%

“…Several studies support their use, finding that otitis‐prone implantees had no complications attributable to their VTs . Additionally, a recent review of the literature by Preciado and Choi favors the use of tubes in patients prone to OM; however, the authors acknowledge that there is a lack of large, comprehensive studies of this topic . On the contrary, many otologists steadfastly oppose the use of VTs in an implanted ear, citing a risk for contamination of the cochlear implant by organisms from the ear canal.…”

Section: Discussionmentioning

confidence: 99%

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Infectious complications and ventilation tubes in pediatric cochlear implant recipients

et al. 2015

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Infectious complications and ventilation tubes in pediatric cochlear implant recipients

et al. 2015

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“…A review by Preciado and Choi 196 supports the recommendations of using a tympanostomy tube in otitis‐prone children undergoing cochlear implantation 197 . The authors concluded that the preponderance of published evidence and policy statements argue in favor of using tubes in children with recurrent AOM undergoing cochlear implantation, with no evidence showing increased infectious complications from the presence of a tube.…”

Section: Guideline Key Action Statementsmentioning

confidence: 99%

Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)

Rosenfeld

Tunkel

Schwartz

et al. 2022

Otolaryngol.--head neck surg.

164

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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. All these conditions are encompassed by the term otitis media (middle ear inflammation). This guideline update provides evidence-based recommendations for patient selection and surgical indications for managing tympanostomy tubes in children. The guideline is intended for any clinician involved in managing children aged 6 months to 12 years with tympanostomy tubes or children being considered for tympanostomy tubes in any care setting as an intervention for otitis media of any type. The target audience includes specialists, primary care clinicians, and allied health professionals. Purpose The purpose of this clinical practice guideline update is to reassess and update recommendations in the prior guideline from 2013 and to provide clinicians with trustworthy, evidence-based recommendations on patient selection and surgical indications for managing tympanostomy tubes in children. In planning the content of the updated guideline, the guideline update group (GUG) affirmed and included all the original key action statements (KASs), based on external review and GUG assessment of the original recommendations. The guideline update was supplemented with new research evidence and expanded profiles that addressed quality improvement and implementation issues. The group also discussed and prioritized the need for new recommendations based on gaps in the initial guideline or new evidence that would warrant and support KASs. The GUG further sought to bring greater coherence to the guideline recommendations by displaying relationships in a new flowchart to facilitate clinical decision making. Last, knowledge gaps were identified to guide future research. Methods In developing this update, the methods outlined in the American Academy of Otolaryngology–Head and Neck Surgery Foundation’s “Clinical Practice Guideline Development Manual, Third Edition: A Quality-Driven Approach for Translating Evidence Into Action” were followed explicitly. The GUG was convened with representation from the disciplines of otolaryngology–head and neck surgery, otology, pediatrics, audiology, anesthesiology, family medicine, advanced practice nursing, speech-language pathology, and consumer advocacy. Action Statements The GUG made strong recommendations for the following KASs: (14) clinicians should prescribe topical antibiotic ear drops only, without oral antibiotics, for children with uncomplicated acute tympanostomy tube otorrhea; (16) the surgeon or designee should examine the ears of a child within 3 months of tympanostomy tube insertion AND should educate families regarding the need for routine, periodic follow-up to examine the ears until the tubes extrude. The GUG made recommendations for the following KASs: (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, from the date of onset (if known) or from the date of diagnosis (if onset is unknown); (2) clinicians should obtain a hearing evaluation if OME persists for 3 months or longer 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 AND documented hearing difficulties; (5) clinicians should reevaluate, at 3- to 6-month intervals, children with chronic OME who do 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; (6) clinicians should not perform tympanostomy tube insertion in children with recurrent acute otitis media who do not have middle ear effusion in either ear at the time of assessment for tube candidacy; (7) clinicians should offer bilateral tympanostomy tube insertion in children with recurrent acute otitis media who have unilateral or bilateral middle ear effusion at the time of assessment for tube candidacy; (8) clinicians should determine if a child with recurrent acute otitis media 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; (10) the clinician should not place long-term tubes as initial surgery for children who meet criteria for tube insertion unless there is a specific reason based on an anticipated need for prolonged middle ear ventilation beyond that of a short-term tube; (12) 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; (13) clinicians should not routinely prescribe postoperative antibiotic ear drops after tympanostomy tube placement; (15) clinicians should not encourage routine, prophylactic water precautions (use of earplugs or headbands, avoidance of swimming or water sports) for children with tympanostomy tubes. The GUG offered the following KASs as options: (4) clinicians may perform tympanostomy tube insertion in children with unilateral or bilateral OME for 3 months or longer (chronic OME) AND symptoms that are likely attributable, all or in part, to OME that include, but are not limited to, balance (vestibular) problems, poor school performance, behavioral problems, ear discomfort, or reduced quality of life; (9) clinicians may perform tympanostomy tube insertion in at-risk children with unilateral or bilateral OME that is likely to persist as reflected by a type B (flat) tympanogram or a documented effusion for 3 months or longer; (11) clinicians may perform adenoidectomy as an adjunct to tympanostomy tube insertion for children with symptoms directly related to the adenoids (adenoid infection or nasal obstruction) OR in children aged 4 years or older to potentially reduce future incidence of recurrent otitis media or the need for repeat tube insertion.

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“…The lack of adverse events after treatment with oral antibiotics was confirmed in a later prospective study, which found no OM-related complications [10]. The question of whether myringotomy tubes are safe in the setting of a new CI has also been debated, due to a perceived concern with exposing the middle ear space to the ear canal [11]. However, a number of studies have shown no increased risk of tube-related complications after CI [12–16], and others encourage this practice in children with recurrent acute otitis media (AOM) after CI [14,17].…”

Section: Introductionmentioning

confidence: 99%

Infectious complications of pediatric cochlear implants are highly influenced by otitis media

Vila

Ghogomu

John

et al. 2017

International Journal of Pediatric Otorhinolaryngology

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Objective: Determine the incidence of ear infections in cochlear implant patients, evaluate the contribution of otitis media to complications, describe the bacteriology of otitis media in the cochlear implant population, the treatment provided at our center, and the long term outcome. Methods: Data collected included age at implantation, history of otitis media or ear tubes, etiology of hearing loss, inner ear anatomy, postoperative infections, time to infection, route of antibiotic administration, and interventions for infections. Categories of infection were acute otitis media, otitis media with effusion, tube otorrhea, meningitis, scalp cellulitis, and infection at the implant site. Results: Middle ear infections were diagnosed in 37% of implanted ears. Extension of middle ear infections into the implant site occurred in 2.8% of all implants (n = 16). Of the 16 infected devices, 10 were successfully treated with antibiotic therapy and did not require explantation. The retained implant group and explanted group both included some middle ear microbes such as Haemophilus influenzae and Streptococcus pneumoniae, as well as skin flora such as Staphylococcus aureus. Conclusion: Otitis media in pediatric cochlear implant patients is a common event and usually does not lead to complications of the cochlear implant. However, when the ear infection spreads to the scalp and the implant site, it is still possible to eliminate the infection using antibiotic therapy, particularly when treatment is directed to the specific organism that is recovered from the infected space and the duration and route of antibiotic treatment is carefully considered.

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Management of acute otitis media in cochlear implant recipients: To tube or not to tube?

Cited by 8 publications

References 5 publications

Infectious complications and ventilation tubes in pediatric cochlear implant recipients

Infectious complications and ventilation tubes in pediatric cochlear implant recipients

Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)

Infectious complications of pediatric cochlear implants are highly influenced by otitis media

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