Clinical Guidelines Issued for Tympanostomy Tubes in Children

Statement 2: Recommend
An age-appropriate hearing test should be obtained if OME persists for three months or longer OR prior to surgery in a child who is a candidate for tympanostomy tube insertion.

Statement 3: Recommend
Bilateral tympanostomy tube insertion should be offered to children who have bilateral OME for three months or longer AND documented hearing difficulties.

Statement 4: Option
Tympanostomy tube insertion may be performed in children with unilateral or bilateral OME for three months or longer AND symptoms likely attributable to OME (e.g., vestibular problems, poor school performance, behavioral problems, ear discomfort, reduced quality of life).

Statement 5: Recommend
Children with chronic OME who do not receive tympanostomy tubes should be reevaluated at three- to six-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.

Statement 6: Recommend (Against)
Tympanostomy tube insertion should NOT be performed in children with recurrent AOM who do not have MEE in either ear at the time of assessment for tube candidacy.

Statement 7: Recommend
Bilateral tympanostomy tube insertion should be offered to children with recurrent AOM who have unilateral or bilateral MEE at the time of assessment for tube candidacy.

Statement 8: Recommend
Children with recurrent AOM or with OME of any duration should be assessed to see if they are at increased risk for speech, language or learning problems from OM because of baseline sensory, physical, cognitive or behavioral factors.

Statement 9: Option
Tympanostomy tube insertion may be performed in at-risk children with unilateral or bilateral OME that is unlikely to resolve quickly (i.e., as indicated by a type of B (flat) tympanogram or persistence of effusion for three months or longer).

Statement 10: Recommend
Caregivers of children with tympanostomy tubes should be educated before surgery as to the expected duration of tube function, recommended follow-up schedule and detection of complications.

Statement 11: Strongly Recommend
Topical antibiotic eardrops only, without oral antibiotics, should be prescribed for children with uncomplicated acute tympanostomy tube otorrhea.

Statement 12: Recommend (Against)
Routine prophylactic water precautions (i.e., use of earplugs, headbands, avoidance of swimming or water sports) should NOT be encouraged for children with tympanostomy tubes.

Source: Otolaryngol Head Neck Surg. 2013;149:S9