Timing for Removal of Asymptomatic Long-Term Ventilation Tube in Children

Abdel-NabyAwad, Osama G.

doi:10.1007/s12070-015-0843-6

Cited by 13 publications

(16 citation statements)

References 47 publications

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“…Notably, at about 18 months, 90% of placed tubes had spontaneously extruded and the rate of extrusion plateaued thereafter. The authors noticed increased complications as the duration of intubation increased (>12 months) similar to the findings of Abdel‐NabyAwad 1 . The OME recurrence rate significantly decreased after 12 months following spontaneous tube extrusion (11.2% vs. 21.9%).…”

Section: Literature Reviewsupporting

confidence: 74%

“…Abdel‐NabyAwad 1 performed a prospective study on 120 pediatric patients (240 ears) from 6 to 12 years old with persistent OME in whom Goode T‐tubes were employed. Patients were randomly divided into four groups according to the intubation period (6, 12, 18, and 24 months).…”

Section: Literature Reviewmentioning

confidence: 99%

“…Reference 5 is a systematic review of cohort studies (level 2), Reference 1 is a prospective study (level 2), and References 2–4, and are retrospective studies (level 3).…”

Section: Level Of Evidencementioning

confidence: 99%

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When Should a Retained Tympanostomy Tube be Removed?

2021

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BACKGROUNDPlacement of tympanostomy tubes is one of the commonest ambulatory procedures performed in the pediatric population. Tympanostomy tube placement has been shown to significantly improve speech and hearing, as well as reduce the rates of effusion and recurrent acute otitis media (AOM). The main indications of tympanostomy tube are recurrent AOM with middle ear effusion, chronic otitis media with effusion (OME), and Eustachian tube (ET) dysfunction. The majority of tympanostomy tubes self-extrude within 6 to 18 months due to the natural epithelial migration of tympanic membrane (TM); tubes that fail to spontaneously extrude for more than 2 years are considered retained and may require manual removal in office or in the operating theatre under general anesthesia. Currently, there are no guidelines for the management of retained tubes in asymptomatic patients. Should they be removed? If so, when? Hence, the purpose of this Triological Best Practice is to examine the current best evidence to determine when should a retained tympanostomy tube be removed in children.

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Section: Literature Reviewsupporting

confidence: 74%

Section: Literature Reviewmentioning

confidence: 99%

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When Should a Retained Tympanostomy Tube be Removed?

2021

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“…281,282 One chart review 283 showed low rates of otorrhea, granulation tissue, and persistent perforation when tubes were removed after 2 to 3 years, but rates increased to >50% for all complications with intubation for 5 years or longer. A retained T-tube or other silicone tube can be easily removed in the office setting, 284 but a rigid grommet-type tube may require general anesthesia in an operative setting for removal.…”

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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“…This finding was consistent with the other studies that showed a higher recurrence rate once that extrusion time was less than 12 months. 16 , 17 …”

Section: Discussionmentioning

confidence: 99%

Predictors of tympanostomy tube extrusion time in otitis media with effusion

Alaraifi

Alkhaldi

Ababtain

et al. 2022

SMJ

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Objectives: To investigate the impact and predictors of tympanostomy tube )TT( extrusion.Methods: A retrospective study on 258 ears underwent TT insertion during 2016-2018 at King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia. Patients were followed for 36-48 months postoperatively to detect the recurrence rate. The sample was divided into 2 groups based on extrusion time and were compared to determine the predictors of TT extrusion.Results: Otitis media with effusion )OME( recurrence after TT insertion was detected in 28.7%. A shorter TT extrusion time was associated with a higher recurrence )p=0.002(. Small TTs increased the probability of early TT extrusion )odds ratio = 5.144; 95% confidence interval: [1.602-16.519](. Conclusion:More than one-fourth of the patients who underwent TT insertion for OME developed Original Articlerecurrence. Tympanostomy tube extrusion earlier than 12 months was associated with a higher recurrence rate. Small TTs increased the probability of early TT extrusion.

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Timing for Removal of Asymptomatic Long-Term Ventilation Tube in Children

Cited by 13 publications

References 47 publications

When Should a Retained Tympanostomy Tube be Removed?

When Should a Retained Tympanostomy Tube be Removed?

Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)

Predictors of tympanostomy tube extrusion time in otitis media with effusion

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