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    Finally, clear guidelines for tympanostomy tubes

     

    CORRECTION

    The article “Finally, clear guidelines for tympanostomy tubes” that appeared in the July 11 edition of the eConsult should have read:

    “Clinicians should prescribe topical antibiotic eardrops only, without oral antibiotics, for children with uncomplicated acute tympanostomy tube otorrhea.”

    Contemporary Pediatrics regrets the error.


    At last, clear guidelines emerge for the placement of tympanostomy tubes in children. A multidisciplinary panel associated with the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) has devised a 12-point clinical practice guideline regarding conditions for placement, perioperative management, and postoperative care and outcomes in children aged 6 months to 12 years.

    According to 1 study, almost 7% of children aged younger than 3 years in the United States have tympanostomy tubes.

    The new guideline recommends that physicians should not insert tubes after only 1 episode of otitis media with effusion (OME), nor should they insert tubes in children with recurrent acute otitis media (AOM) who do not have middle ear effusion (MEE) in either ear.

    They should obtain an age-appropriate hearing test before inserting tubes.

    They should offer tubes to children with chronic bilateral OME (3 months or longer) with documented hearing difficulty and to those with recurrent AOM who have unilateral or bilateral MEE.

    Physicians should consider tubes for children with unilateral or bilateral OME lasting 3 months or longer and symptoms that are likely attributable to OME, such as balance (vestibular) problems, poor school performance, behavioral problems, ear discomfort, or reduced quality of life.

    They also should consider tubes for children with unilateral or bilateral OME that is unlikely to resolve quickly, as indicated by a type B (flat) tympanogram or effusion lasting 3 months or longer.

    They should monitor children with chronic OME not receiving tubes at 3- to 6-month intervals until the effusion is no longer present, significant hearing loss is detected, or structural abnormalities of the tympanic membrane or middle ear are suspected.

    They should not prescribe topical antibiotic eardrops without oral antibiotics for children with uncomplicated acute tympanostomy tube otorrhea.

    Finally, it is not necessary for physicians to instruct children to stay out of the water. No headbands, earplugs, or other prophylactic measures are needed.

    The clinical practice guideline is intended for pediatricians, primary care physicians, specialists, and other allied health professionals who manage otitis media in pediatric patients.


    To get weekly clinical advice for today's pediatrician, subscribe to the Contemporary Pediatrics eConsult.

    2 Comments

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    • Dr. De la Cruz
      for uncomplicated otorrhea WITH tympanostomy tubes---just drops, NO systemic antibiotics!! Your summary states something else.
    • Anonymous
      There appears to be an error in the above article. "They should not prescribe topical antibiotic eardrops without oral antibiotics for children with uncomplicated acute tympanostomy tube otorrhea." The actual guideline recommends treating only with topical antibiotics, and not using oral antibiotics.

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